Critical Incident/Threat Report
NOTE: The contents of this document shall
be kept confidential with its contents released only to
individuals with a legitimate need to know or unless it
becomes public record by virtue of an appeal to a court or
other adjudicative body. |
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CRITICAL INCIDENT STATEMENT |
| Date of
Incident |
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Place of
Incident |
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| Time
Incident Began |
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Time
Incident Ended |
|
| Name of
Person Making Statement |
|
Phone No. |
|
| Title |
|
Work
Location |
|
Detail description of incident. Answer
the questions, WHO, WHAT, WHEN, WHERE, HOW, and WHY. (If
necessary, continue on plain paper; attach sheets.)
Completed statement should be forwarded to appropriate
personnel. |
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Report
Completed By: |
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Date: |
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