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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