Government Building Incident Report Form
Use this form to report an incident that occurred in a government building, including what happened, where it happened, who was involved, and what actions were taken.
Incident Details
Incident Date
*
-
Month
-
Day
Year
Date
Incident Time
*
Hour Minutes
AM
PM
AM/PM Option
Government Building / Facility Name
*
Exact Location Within Building
*
Please Select
Lobby
Reception Area
Security Checkpoint
Hallway
Stairwell
Elevator
Office
Conference Room
Restroom
Parking Area
Exterior Entrance
Other
Incident Type / Category
*
Accident
Security Concern
Property Damage
Medical Emergency
Unauthorized Access
Fire/Smoke
Utility Issue
Disruptive Behavior
Other
Detailed Incident Description
*
Reporter and Involved Parties
Reporter’s Full Name
*
First Name
Middle Name
Last Name
Job Title or Role
*
Department or Office
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
People Involved or Affected (names and roles)
*
Witness Name(s) and Contact Information
Impact, Actions, and Follow-Up
Anyone injured or required medical attention?
*
Yes
No
Brief injury or medical details
Property damage description
Estimated damage severity or extent
Please Select
None
Minor
Moderate
Severe
Extensive
Other
Immediate actions taken
Were security, facilities, or management notified?
*
Yes
No
Notification details (who was notified and when)
Requested follow-up actions or additional notes
Submit Incident Report
Should be Empty: