• Delivery Assault Incident Report Form

    Use this form to document delivery-related threats, harassment, assault, or other safety incidents as accurately as possible.

  • Reporter Information

  • Format: (000) 000-0000.
  • Preferred contact method*

  • Incident Details

  • Incident Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Incident Time*

  • People Involved and Witnesses

  • Were there any witnesses?*
  • Was the assailant known to you or the customer?

  • Incident Narrative and Impact

  • Were any injuries sustained?*
  • What was damaged?
  • Who was contacted?
  • Was medical attention sought?
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    • Follow-up details if injuries or damage were reported 
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