Incident Report - Glitch

• Reported By

Incident Details

• Date and time of incident

  Date

• Place of the Incident

  Media

• Description of the Incident?

• Were there any injuries?

  Yes

  No

• Description of injury

• Take photo of injury

  Media

• Was there any damage to property or venue?

  Yes

  No

• Description of damage

• Take photo of damage

  Media

• What actions will be taken to eliminate future repeats of the incident?

Sign Off

• Attendant/ witness signature

  Sign

• Signed off by supervisor

  Sign

• Comments

  Yes

  No

  N/A