INSTRUCTIONS: For each question answered "Yes" above, please copy and paste the corresponding details section into the "Online Report Details" box below.

Medical Details (If "Yes" to "Were there any injuries/illnesses?")
Include the below information for EACH patient involved in the incident

1. Patient First Name:
2. Patient Last Name:
3. Patient Age:
4. Chief Complaint (ex. Headache):
5. Medical Disposition (ex. Taken to Med Tent):
6. Was the patient taken to the hospital? If "yes", what hospital?:
7. Ask: "In your own words, please tell me what treatment was provided to you":
8. Ask: "In your own words, please tell me what the reason was for you needing treatment":
9. Is the patient an official, spectator, vendor, media rep, contractor, employee, or other?
10. What department was the patient associated to, if any?

Property Damage Details (If "Yes" to "Was any property damaged?")

1. Name of Individual Causing Damage:
2. If staff or vendor, who is the individual's employer?:
3. In the past 24 hours, has the person causing damage consumed any drugs or alcohol?:
4. Owner of Damaged Property:
5. Was the owner notified of the damage?:
6. Owner Contact Info:
7. Estimated Cost of Damage (USD):
8. Description of Property Damage:
9. Attach photos of all damage caused in the "Attachments" section at the bottom of this form.
10. Attach a photo of the individual causing damage's ID or driver's license in the "Attachments" section at the bottom of this form.

Fire Details (If "Yes to "Was there a fire or smoke?")

1. What was the source of the fire/smoke?:
2. Did the Fire Department respond?:
3. Fire Department Statement and/or Report Number:
4. Attach photos of fire/area in the "Attachments" section at the bottom of this form.

Altercation Details (If "Yes" to "Was there an altercation?")

1. Names of Individuals:
2. Association to Event (ex, Staff, Vendor, or Attendee):
3. Was any individual injured during the altercation? If yes, include "Medical Details" above:
4. In the past 24 hours, has anyone involved consumed any drugs or alcohol?:
5. Was anyone arrested?:
6. Was anyone trespassed (by law enforcement)?:
7. Was anyone evicted (removed from site)?:
8. Attach a photo of all individual's IDs or driver's licenses in the "Attachments" section at the bottom of this form.

For each witness to the event, include the following information in the "Witness Details" section below. If the witness is a member of staff or a vendor, they should also complete an incident report, in addition to being listed below.

1. Witness First Name:
2. Witness Last Name:
3. Witness Department/Company:
4. Witness Address:
5. Witness Phone Number:
6. Witness Email: