Employee Behavior Incident Report

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Location of incident (print) Name of individual reporting incident (print) Name(s) of all persons involved in the incident (print) Name(s) of other witness(es) (print) Did physical violence or damage to property occur NO YES Was the safety of a person endangered NO YES Any evidence from the incident (e-mails, photos, etc.) NO YES If yes, describe: Was the Police Department contacted NO YES If yes, name of contact at Police Department Detailed description of incident (be sure to name all of the individuals involved) Report prepared by: Signature Phone Number Date of Report: To be submitted to supervisor or department head for immediate transmittal to Kim Hall (Human Resources) and John Beyer (Police Department)..

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