Employee Incident Report

Name *

First Name

Last Name

Phone Number *

Country

(###)

###

####

Please select the reason for this incident report.

Select all that apply

Threats To You or Others

Refund Request

Sexual Harassment

Aggressive Behaviors

Confession of A Crime

Internet Hacking

Other

Does This Incident Require Mandated Reporting?

What actions did you take to rectify the incident (outside of completing this form)? *

Select all that apply.

Termination Of Call

Contact with On-Call Supervisor/Administrator

Contact With Emergency Services

Other

No Action Taken