Incident Reporting Protocol Checklist

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Incident Identification & Initial Response

1 of 8

Focuses on recognizing incidents, ensuring immediate safety, and providing initial support to those involved.

Type of Incident?

Brief Description of Incident

Exact Location of Incident

Time of Incident

Immediate Actions Taken?

Number of People Involved

Description of Immediate Response (e.g., first aid administered, area secured)

Photos/Videos of Scene (if applicable)

Reporting Procedures

2 of 8

Details the steps to formally report the incident, including who to notify and required information.

Incident Severity Level

Reporting Method Used

Brief Description of Incident

Number of People Involved

Date of Incident

Time of Incident

Specific Location of Incident

Initial Response Team Contacted (if applicable)

Name of Person Completing Report

Documentation & Record Keeping

3 of 8

Covers the accurate and thorough recording of incident details and related documents.

Date of Incident

Time of Incident

Specific Location of Incident

Detailed Description of Incident (including what happened, who was involved, and any immediate actions taken)

Number of People Directly Affected

Statements from Involved Parties (witnesses, victims, staff)

Photographs or Video Evidence (if applicable)

Type of Incident (e.g., Injury, Property Damage, Security Breach)

Reporting Staff Member Name

Reporting Staff Member Signature

Investigation & Analysis

4 of 8

Outlines the process for investigating the incident, identifying root causes, and determining corrective actions.

Detailed Description of Incident Circumstances

Potential Contributing Factors

Number of Witnesses

Precise Incident Location (GPS coordinates or detailed description)

Witness Statements (if applicable)

Severity Assessment (e.g., Minor, Moderate, Severe)

Date of Investigation

Time of Investigation Started

Corrective Actions & Follow-Up

5 of 8

Focuses on implementing solutions to prevent recurrence and monitoring their effectiveness.

Root Causes Identified (Select all that apply)

Detailed Description of Corrective Actions

Planned Completion Date for Corrective Actions

Estimated Cost of Corrective Actions

Departments Involved in Corrective Actions (Select all that apply)

Date Corrective Actions Implemented

Summary of Verification/Validation Process (How was the effectiveness of corrective actions verified?)

Effectiveness of Corrective Actions

Any Unexpected Outcomes or Challenges during Corrective Actions

Communication & Stakeholder Management

6 of 8

Addresses communicating incident details to relevant parties and managing their expectations.

Select Primary Contact Method for Initial Notification:

Summary of Communication Made to Affected Guests/Customers:

Was Legal Counsel Notified?

Was Insurance Company Notified?

Record of Communication with Regulatory Bodies (e.g., Health Department, Tourism Board):

Date of Initial Communication with Stakeholders

Time of Initial Communication with Stakeholders

Select all stakeholders notified:

Training & Awareness

7 of 8

Ensures all staff understand their responsibilities regarding incident reporting and prevention.

Employee Name

Training Module Completed (Select all that apply)

Training Completion Date

Briefly describe your understanding of incident reporting responsibilities.

Which of the following are common incident types you should report?

Who should you initially contact in case of an incident?

Review & Improvement

8 of 8

Establishes a process for periodically reviewing the incident reporting protocol and making necessary adjustments.

Date of Last Protocol Review

Summary of Review Findings

Areas for Potential Improvement Identified?

Number of incidents reported since last review?

Detailed Description of Proposed Changes

Target Date for Implementation of Changes

Review Approved by (Select Position)

Reviewer Signature

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