Information
CRIME & ASSAULT REPORT FORM
Assault & Crime Report
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Date Reported
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Reported by - free text
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Job Title
- Conductor
- Conductor Manager
- Driver
- Driver Highspeed
- Driver Trainee
- Driver Instructor
- Driver Manager
- Duty Station Manager
- Engineering Staff
- Gateline
- Local Operations Manager
- Office Staff (including managers)
- On Board Manager
- Platform Staff
- Railway Enforcement
- Revenue Protection
- Shunter Driver
- Station Manager
- Ticket Office Staff
INCIDENT DETAILS
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Date and time of incident
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Reported to KICC
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Reported to BTP or Local Police?
- BTP
- Local Police
- Both
- Neither
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Reference number if applicable
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Complete description of the event - free text
-
Weapon Used?
- Yes
- No
- Unknown
- Not Applicable
-
Alcohol Related?
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Other signs of intoxication?
LOCATION DETAILS
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Location of Incident - free text
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Further Location Details - free text
TRAIN DETAILS
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Train ID
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Booked Departure Time
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Train Origin
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Train Destination
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Leading Unit Number
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2nd Unit Number
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3rd Unit Number
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Coach Number(s)
EMPLOYEE DETAILS (if applicable)
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Employee Name
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Based at
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Job Title
- Conductor
- Conductor Manager
- Driver
- Driver Highspeed
- Driver Trainee
- Driver Instructor
- Driver Manager
- Duty Station Manager
- Engineering Staff
- Gateline
- Local Operations Manager
- Office Staff (including managers)
- On Board Manager
- Platform Staff
- Railway Enforcement
- Revenue Protection
- Shunter Driver
- Station Manager
- Ticket Office Staff
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Number of Days Lost Due to Incident
NON EMPLOYEE DETAILS (if applicable)
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Person Type
- Contractor
- Member of Public
- Passenger
- Trespasser
- Other
- Unknown
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Title
- Master
- Miss
- Mrs
- Ms
- Mr
- Unknown
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First Name
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Surname
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Apparent Age
- 5 years or less
- 5-10 years
- 11-15 years
- 16-20 years
- 21-30 years
- 31-40 years
- 41-50 years
- 51-60 years
- 61-70 years
- 71-80 years
- Over 80 years
- Unknown
ASSAILANT DETAILS
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Person Type
- Contractor
- Member of Public
- Passenger
- Trespasser
- Other
- Unknown
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Title
- Master
- Miss
- Mrs
- Ms
- Mr
- Unknown
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First Name
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Surname
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Apparent Age
- 5 years or less
- 5-10 years
- 11-15 years
- 16-20 years
- 21-30 years
- 31-40 years
- 41-50 years
- 51-60 years
- 61-70 years
- 71-80 years
- Over 80 years
- Unknown
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Description of suspect including any distinguishing marks - free text
DESCRIPTION OF INJURIES SUSTAINED/PROPERTY DAMAGED
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Description of Injuries Sustained
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Injury Confirmed
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First Aid Administered
- Ambulance/Paramedic
- Doctor
- Other Person (Non Workforce)
- Other Person (Workforce)
- Self Administered
- Trained First Aider
- Nurse
- Other
- None
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Person Taken Direct to Hospital
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Kept in Hospital More Than 24hrs
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Alcohol Related
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Other Signs of Intoxication
DATE AND SIGN
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Date
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Signed
