Use to report any occurrence (whether by action or omission) that is not consistent with routine operations or procedures. Examples: Employee injury, Tenant/Owner threatens lawsuit, Legal action, A situation where legal action is likely. Your Name* First Last Date incident occurred* MM slash DD slash YYYY NAMES OF ALL EMPLOYEES AND NON EMPLOYEES INVOLVED (Indicate relationship as Employee, Customer, Vendor, etc.)NAME(S) OF WITNESS(ES)Give DETAILED DESCRIPTION of the incident (What, Where, When and Why)*NAME OF SUPERVISOR NOTIFIED* First Last ACTION TAKENFOLLOW-UP REQUIRED?* Yes No
