INCIDENT REPORT
Title: Incident Report
Community:
Date of Report:
Date of Incident:
Time of Incident:
Incident Location:
Written By:
Type of Incident: (Notification Level is indicated below) Level 1
Level 2*
Level 3*
Roommate conflict
Drug Dealing
Property Loss
Noise/Disturbance
Theft/Burglary
Assault
Vandalism
Serious Injury
Home Intrusion
Alcohol Use
Threat of Injury to Self/Others
Fire
Drug Use
Suicide Attempt
Minor Property Damage
Death
Other:__________________________________________________________________________________
_______________________________________________________________________________________ _____________________________________________________________. *Level 2 & Level 3 Incidents require phone contact with Portfolio Manager and/or Vice President in accordance with Incident Reporting Procedures. Person(s) involved- Resident & Non-Resident: Name
Apt #
Contact Information
Apt #
Contact Information
Witnesses – Resident & Non-Resident: Name
Did reporting party visit the office in person, call, e-mail or other? Yes No Method of Contact:
__________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________
Page 1 of 3
Title: Incident Report
Summary of Incident:
Specific Statements made by Parties involved:
Estimated Resident or Property Loss (Description & Dollar Value):
Was a Police Report Filed:
Yes
No
Case #
Does Resident have Insurance
Yes
No
Policy #
Were Pictures Taken (attach):
Yes
No
. .
Follow-up action taken by management:
Notification Procedure: Community Manager is to send copy of all incident reports and attachments to Portfolio Manager or Vice President within 24 hours of incident (original report is to be maintained on site with a copy placed in resident’s file, if applicable) Photographs, police reports, and any other back up documentation should be kept as attachments with the original incident report. Attach a copy of Resident Crime Notification Letter to Incident Report if applicable Date that Incident Report was sent to Portfolio Manager or Vice President: ________________
Page 2 of 3
Title: Incident Report
External Contact Log (May not be applicable to all incidents. To be completed by CM and PM): Type of Contact Emergency Services
Name of Contact
Date of Contact
Results of Contact
Date of Contact
Results of Contact
Campus Administrators Guarantor Emergency Contact Media Outlets (Corporate Contact ONLY) Key Partner Organizations (i.e. Red Cross) Vendor or Contractor Services Internal Contact Log (May not be applicable to all incidents.): To Be Completed By: CM PM/VP PM/VP/CEO
Contact Portfolio Manager or VP President/CEO Owner
Insurance Carrier Contact: (Contact made by either PM/VP or Owner, dependent on insurance policy specific to property): Completed By:
Person Contacted
Date of Contact
Results of Contact
Page 3 of 3