Martinez Distributors

STORE INCIDENT REPORT

Complete it at the site of the damage or immediately after the incident occurs. Ask the affected if you can pictures and document as much as possible any info about the incident.
Date of Incident
Data of the injured or affected
Name of the injured person
Phone of the injured person
Email of the injured person
Address of the injured person
Description of the Incident
Description of the injury or affection (part of the body etc)
Witness
Witness Name
Phone witness
Treatment given
Ambulance called
Manager contacted
Date completed
Form completed by
Attach all picture evidence (To select multiple files, hold down the CTRL or SHIFT key while selecting -Max 20Mb-)