Refrigerator Door Left Open Incident Report
Please complete this form to report and document any incidents involving a refrigerator door being left open.
Full Name of Reporter
*
First Name
Last Name
Email Address
*
example@example.com
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 Refrigerator
*
How long was the refrigerator door left open (estimated)?
*
What was the cause of the door being left open?
*
Accidental (forgot to close)
Obstruction prevented closing
Mechanical issue (door malfunction)
Other
Were any items spoiled or affected?
*
Yes
No
Not sure
Describe any items that were spoiled or affected (if applicable)
What corrective actions were taken?
*
Closed the door
Removed spoiled items
Cleaned refrigerator
Notified supervisor or maintenance
Other
Is this a recurring issue with this refrigerator?
*
Yes
No
Not sure
Upload photos (if any) of the incident or affected items
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional comments or follow-up needed
Submit Report
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