Hotel Incident Report
Date:
Time:
Case number
Who is reporting the situation?
Department:
--Please choose an option--
Front Desk
Monitor
Security Officer
Loss Prevention
Housekeeping
Food and Beverage
Engineering
Marketing
Human Resources
Guest
Valet
AYS
Recreation
Occean Club
Gingambo
La Panaderia
Banquets
Lobby Bar
Pool Bar
Beach Bar
Type of Person:
+
--Please choose an option--
Baby
Boy
Girl
Teenager
Gentleman
Lady
Employee
Where it happened:
Room
Lobby
Drive Way
Casino
Upper Pool
Lower Pool
Beach
Lobby Bar
Beach Bar
Pool Bar
Restaurant
Full Name:
Person Age:
--Please choose an option--
Less 1 Year
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
17 Years
18 Years
Adult
Type of Visitor:
--Please choose an option--
Tower
Cabana
Guest Without Room
Restauran Customer
Casino Customer
No Guest
Employee
Floor:
--Tower--
3rd Tower floor
4th Tower floor
5th Tower floor
6th Tower floor
7th Tower floor
8th Tower floor
9th Tower floor
10th Tower floor
11th Tower floor
12th Tower floor
14th Tower floor
15th Tower floor
16th Tower floor
17th Tower floor
18th Tower floor
19th Tower floor
20th Tower floor
21st Tower floor
Floor:
--Cabana--
1st Cabana floor
2nd Cabana floor
3rd Cabana floor
4th Cabana floor
5th Cabana floor
6th Cabana floor
7th Cabana floor
8th Cabana floor
9th Cabana floor
+
Room:
--Select a number--
01
02
03
04
05
06
07
08
09
10
11
12
14
15
16
17
18
19
20
21
22
23
24
25
+
Room:
--Select a number--
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
+
What happened:
Slipped and Fell - Pain
Slipped and Fell - Cut
Slipped and Fell - Injury
Tripped and Fell - Pain
Tripped and Fell - Injury
Fell Down Stairs - Pain
Fell Down Stairs - Injury
Physical Assault - Pain
Physical Assault - Injury
Robbery - Gunpoint
Robbery - Loss
Heart Attack
Stroke
Allergic Reaction
Seizure
Hazardous Materials
Stuck in Elevator
Power Outage
Gas Leak
Fight - Pain
Fight - Cut
Bumped
Minor Cut
Not Listed
More Details about the incident:
Clear
Close
What injuries:
Head
Neck
Chest
Abdomen
Back
Hip
Left Shoulder
Right Shoulder
Both Shoulders
Both Arms
Left Arm
Right Arm
Both
Left Elbow
Right Elbow
Both
Left Elbow
Right Elbow
Both Hand
Left Hand
Right Hand
Both Foot
Left Foot
Right Foot
Both Knee
Left Knee
Right Knee
Both Leg
Left Leg
Right Leg
Both Ankle
Left Ankle
Right Ankle
Fingers:
--Select finger--
Thumb
Index finger
Middle finger
Ring finger
Pinky finger
All Fingers
Toes:
--Select the toes--
Hallux (big toe)
Second toe (index toe)
Third toe (middle toe)
Fourth toe (ring toe)
Fifth toe (little toe)
All Fingers
Assistance provided?
No
Yes
Type of medical assistance provided:
Antiseptic Wipe
Triple Antibiotic
Bandage
Ice Pack
AED
Oxygen
Was additional assistance offered?
Yes
No
Did they want additional assistance?
No
Yes
What kind of additional assistance was offered?
Was the option to go to the hospital offered?
Yes
No
Does the person want to go to the hospital?
No
Yes
Which hospital was offered?
--Please choose an option--
Ashford Presbyterian
Centro Medico San Juan
+
Property damage:
No
Yes
Explain Damage:
Create Report
Report: