Workplace Weapon Incident Form
Use this form to report and document a workplace weapon incident, including what happened, who was involved, where and when it occurred, and what immediate action was taken.
Incident Overview
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 / site / department
*
Incident type / status
*
Witnessed
Reported after the fact
Ongoing threat
Weapon found unattended
Weapon brandished
Other
Incident summary
*
People and Weapon Details
Reporter’s Name
*
First Name
Middle Name
Last Name
Reporter’s Email
example@example.com
Reporter’s Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Involved Person’s Name
First Name
Middle Name
Last Name
Involved Person’s Role or Relationship to Workplace
*
Please Select
Employee
Contractor
Visitor
Customer/Client
Vendor/Supplier
Former Employee
Unknown
Other
Weapon Type
*
Please Select
Firearm
Knife/Blade
Blunt Object
Other Specified Weapon
Unknown
Weapon Description
Impact and Response
Immediate Actions Taken
*
Contacted Security
Contacted HR
Contacted Emergency Services
Evacuated Area
Isolated Area
No Immediate Action
Other
Witness Information
Injuries or Property Damage Observed
Reporting Follow-up
*
Escalated to Management
Escalated to Security
Escalated to Both Management and Security
Not Yet Escalated
No Further Action Required
Other
Submit Report
Should be Empty: