ALCOHOL MANAGEMENT_TOOLKIT FDL-FINAL

APPENDIX G: Event Incident Report (Sample)

Event Incident Report Form

Date: _ ________________________________________Time of Day: _____________________________

Reported by: ______________________________________________

Guest Name and Description: _______________________________________________________________ _______________________________________________________________________________________

Non-Alcoholic Drinks Offered: _____________________ Accepted:_______________________________

Alternate Transportation Offered:____________________ Accepted:_______________________________

Description of Incident: ___________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Intervention Used: _______________________________________________________________________ ______________________________________________________________________________________ Other Witnesses: ________________________________________________________________________ ______________________________________________________________________________________

Signatures: ____________________________________________________________________________

Phone Number: _________________________________________________________________________

Incident Follow Up

How was this incident handled by the server? _ ________________________________________________ ______________________________________________________________________________________ Were policies followed? Yes No Explanations: ______________________________________________________________________________________ ______________________________________________________________________________________ Incident Resolution: ______________________________________________________________________________________

______________________________________________________________________________________

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