Violent Incident Report Violent Incident Report IDENTIFYING INFORMATION Type of Incident: Verbal Assault No Yes Verbal Threat No Yes Physical Assault No Yes Employee Name * Job Title Location of Incident * Department Date of Report * Date & Time of Incident * * 121234567891011 : 0030 AMPM Incident Description (Describe the sequence of events) * FOLLOW UP Was the RCMP called? No Yes Note any action taken and/or recommendations DESCRIPTION OF THE INDIVIDUAL Name (if known) Voice Characteristics (check all that apply) Calm No Yes Angry No Yes Cynical No Yes Deep No Yes Slurred No Yes Loud No Yes Stutter No Yes Slow No Yes Raspy No Yes Nasal No Yes Accent No Yes Soft No Yes Deep Breathing No Yes Normal No Yes Physical Characteristics. Provide as much detail as possible such as: Age Sex Race Weight (Build) Height Hair Color/length Eye Color Moustache/beard Moles Scars/tattoos, etc Clothing, jewelry, glasses, makeup, wig? Mental State (alcohol, drugs, unstable) Additional Information/Comments Add Pictures (if needed) Drop a file here or click to upload Choose File Maximum file size: 128MB Captcha Submit If you are human, leave this field blank.
