Security Incident Interview Questionnaire
Please provide detailed information regarding the security incident and your involvement. This form helps ensure a thorough and accurate record.
Interviewee Full Name
*
First Name
Last Name
Interviewee Contact Email
*
example@example.com
Interviewee Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident (Building, Room, Area)
*
What is your role in relation to the incident?
*
Witness
Victim
Suspect
Security Personnel
Other
Please describe the incident in detail
*
Who else was involved or present? (List names and roles if known)
Did you take any immediate actions? If yes, please describe.
Were there any injuries or damages?
*
No
Yes, injuries only
Yes, damages only
Yes, both injuries and damages
Did you submit any evidence (photos, documents, video, etc.)?
*
No
Yes (please upload below)
Upload Evidence (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
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Do you believe further investigation is needed?
*
Yes
No
Unsure
Additional Comments or Information
Name of Interviewer (if different from interviewee)
Submit Incident Report
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