7900 SW 176th Street, Palmetto Bay, FL 33157 www.palmertrinity.org – 305.252.2230
INCIDENT REPORT
INCIDENT TYPE / DESCRIPTION:__________________
LOCATION:
DATE OF INCIDENT: TIME OF INCIDENT: Police Rpt #______________
NARRATIVE OF INCIDENT: (Explain in detail, WHO, WHAT, WHEN, WHERE, WHY and HOW circumstances and cause of the incident)
ACTION TAKEN: (Who investigated? Who was notified? Who was present pre/at/before the incident? Was situation corrected? Video/Pics?)
COMMENTS AND RECOMMENDATIONS: (Further action required? How can future incidents be prevented?)
PREPARED BY NAME / SIGNATURE:
SUPERVISOR’S NAME / SIGNATURE:
DEPARTMENT:
DATE: