Aggressive Visitor Incident Form
Use this form to report an incident involving an aggressive visitor, including what happened, who was involved, what actions were taken, and any injuries, damage, or follow-up needed.
Incident Details
Incident Date
*
 -
Month
 -
Day
Year
Date
Incident Time
*
Hour Minutes
AM
PM
AM/PM Option
Exact Location / Site Area
*
Incident Type / Behavior Observed
*
Yelling
Verbal Abuse
Intimidation
Refusal to Leave
Threatening Gestures
Physical Aggression
Property Interference
Other
Detailed Incident Description
*
Is the Visitor Still on Site?
*
Yes
No
People Involved and Witnesses
Reporter Name
*
First Name
Middle Name
Last Name
Reporter Role / Department
Names or Descriptions of Involved Staff / Affected Persons
Visitor Description
Were There Witnesses?
*
Yes
No
Witness Names or Contactable Descriptions
Additional Witness Statements
Impact and Response
Was anyone injured?
*
Yes
No
Injury details
Was property damaged?
*
Yes
No
Damage details
Any threats made?
Verbal threat
Physical threat
Threat to property
Threat with object
None
Actions taken by staff
De-escalated verbally
Asked visitor to leave
Contacted security
Contacted supervisor
Contacted police
Documented incident
Other
Was security notified?
*
Yes
No
Was police notified?
*
Yes
No
Follow-up actions needed
Supporting attachments
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Additional notes
Submit Incident
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