Fillable Empl Safety Incident Tracker Form Printable (City of Milwaukee (WI))

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Empl Safety Incident Tracker Form Printable (City of Milwaukee (WI))

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City Of Milwaukee
INCIDENT TRACKER FORM
INCIDENT DATE:
DEPARTMENT:
NAME OF EMPLOYEE REPORTING INCIDENT:
TITLE:
TELEPHONE: (
)
LOCATION OF INCIDENT:
Inside the Property Outside the Property Street or Alley Near the Property
ADDRESS, if available:
INCIDENT DESCRIPTION:
INCIDENT CATEGORY
WEAPONS
Shots Fired
Presence of Gun or other weapons
Vicious Dogs/other animals
Weapons Possession Observation
AGGRESSION
Unruly or threatening behavior by
neighbors
Verbal Altercation with Client
Threat of violence
Physical Altercation with Client (Requires
completion of Accident Report)
DRUGS
Public Drinking
Encounter with someone under the influence
Illegal Drugs or Drug activity
Drug Paraphernalia
FIRE
Fire Hazard/Fire Damage
Property Fire
THEFT OR DAMAGE
Damage to City or personal property/car
Theft of city property
Theft of personal property
Car Jacking
Breach attempt/intrusion
Sabotage, tampering, vandalism
SAFETY
Entry/Exit from home or establishment is unsafe or
problematic
Unsafe building structure/conditions
Unsanitary Conditions
Safety Hazard
Presence of hazardous or unknown substance
OTHER
Client complaint
Suspicious activity
Illegal gaming/ gambling
Prostitution/ Other Illegal activities
SEVERITY
Low – Unruly behavior, Safety hazard, Unsanitary condition
Medium – Unlawful behavior/activity, harassment, intimidation
High – Violent behavior, direct threat to employee or others, act of aggression
FOLLOW UP ACTION- NOTIFICATION
MPD District Captain Safety Officer 911 Called On site security
Incident Reported to: ______________________________________________________________ Date: _____________________________
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Empl Safety Incident Tracker Form Printable (City of Milwaukee (WI))

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Completed 13 July 2020

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