Media Interview Incident Report Form
Please provide detailed information about the incident that occurred during a media interview. Complete all sections to ensure a thorough report.
Date and time of the incident
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of the incident
*
Names and roles of individuals involved
*
Media outlet involved
*
Interview format
*
Live (TV/Radio)
Recorded
Print
Online/Podcast
Other
Type of incident
*
Please Select
Technical issue
Miscommunication
Disruptive behavior
Inappropriate question/content
Other
Severity of the incident
*
Low
Moderate
High
Description of what happened
*
Immediate actions taken
*
Recommended follow-up or further actions needed
Submit Report
Should be Empty: