Security Incident Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

Basic Information

• Date and Time of writing this form:

  Date

• Name of person completing report

• Site Address
  Address

Incident information

• Time and date of incident:

  Date
• Location of incident
  Address

• What type of incident occurred?

  Medical

  Fire

  Assault

  Theft

  Other

Patient details:

• Patient name:

• Patient age approx:

• Patient (or guardian) address and contact ph #:

Injury description:

• What type of injury?

  Abrasion (graze)

  Laceration (cut)

  Contusion (bruise)

  Medical Condition

  Sting/Bite/Other

• Details of condition if any: (eg medication)

• Area of injury? e.g. Left Knee

• Cause of injury:

Event log and action taken:

• Ambulance called? (if yes include ambulance number and destination)

  No

  Yes

• Was first aid administered? (if so explain treatment)

  No

  Yes

• Log of events including times and persons involved:

• Was this injury caused by environmental issues? E.g trip hazard

  No

  Yes

• Multiple pictures of area:

  Media

• What action has been taken to rectify this issue? (e.g cones placed) ACTION MUST BE TAKEN.

• Picture of area injury occurred.

  Media

Fire Incident details:

• Was this a real fire? Confirmed and not a false alarm.

  Yes

  No

• Were any injuries caused by this fire?

  No

  Yes

• A SECOND INCIDENT REPORT TO BE COMPLETED FOR "MEDICAL".

• Did the fire panel/fire alarm trigger? List zones.

  Yes

  No

  N/A

• Was the fire department called? (If yes include time on site and fire dept action taken)

  No

  Yes

Action taken:

• Log of events including times and persons involved:

• Did you use any fire fighting equipment? Note what equipment and how. (if extinguishers were used log location taken and picture of equipment)

  No

  Yes

• Photo of area/damage:

  Media

• Photo of area/damage:

  Media

• There is no real fire and this is a confirmed false alarm.

• Did the fire panel activate? Picture of panel and describe location:

  No

  Yes

Action taken:

• Was a full check of the zone in alarm/fault conducted?

  Yes

  No

  N/A

• What was deemed the cause of this activation/fault?

• Actions taken: (eg, isolate the zone, call base etc)

• Photo of the faulty/in alarm activator:

  Media

• Was first aid applied to any persons involved?

  Yes

  No

  N/A

• A SECOND INCIDENT REPORT TO BE COMPLETED FOR "MEDICAL".

• Were restraints used in this incident? If yes explain why.

  Yes

  No

  N/A

• Did police attend site? List time/action taken.

  Yes

  No

  N/A

• Brief log of events:

• Duty manager and base informed.

• Name and contact number of victim:

• Description and estimated price of item stolen:

Offender

• Was the offender caught? If yes, add photo.

  Yes

  No

  N/A

• Is there CCTV footage of the theft? If yes, add times and camera numbers.

  Yes

  No

  N/A

Description

• Gender:

  Male

  Female

• Clothing:

  Select T-Shirt Shirt (collar) Blouse Jacket Hoodie Jeans Pants Dress Skirt Other

  • T-Shirt
  • Shirt (collar)
  • Blouse
  • Jacket
  • Hoodie
  • Jeans
  • Pants
  • Dress
  • Skirt
  • Other

• Define colour, briefly:

• Last known location:

• Log of events:

• Type of incident:

• Log of events:

• Any media:

  Media

Conclusion:

• Additional notes:

• Base and Duty Manager informed of incident

• All relevant and known information added to this report

• At the time of completing this report no further information was available to me.

• Full Name and Signature

  Sign