Incident Report

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:

__________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

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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: ________________

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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

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