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Risk Management Incident Form
Event Details
Date of Incident*
Time of Incident*
12:00 AM
12:30 AM
01:00 AM
01:30 AM
02:00 AM
02:30 AM
03:00 AM
03:30 AM
04:00 AM
04:30 AM
05:00 AM
05:30 AM
06:00 AM
06:30 AM
07:00 AM
07:30 AM
08:00 AM
08:30 AM
09:00 AM
09:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
01:00 PM
01:30 PM
02:00 PM
02:30 PM
03:00 PM
03:30 PM
04:00 PM
04:30 PM
05:00 PM
05:30 PM
06:00 PM
06:30 PM
07:00 PM
07:30 PM
08:00 PM
08:30 PM
09:00 PM
09:30 PM
10:00 PM
10:30 PM
11:00 PM
11:30 PM
Type of Incident*
Injury
Damage to Property
Damage to City Property
Location of Incident(Exact Location)*
Task Number if Applicable
Affected Party Information
Name
Approximate Age
Address
City
State
ZipCode
Email
Injured Person Type
Passenger
Guest
Airport Employee
City Employee
Wearing Glass
Yes
No
Transported To Hospital
Yes
No
Type of Shoe (For trip / fall incidents)
Sandals / Flats
Heels
Athletic / Dress
No shoes
Traveller
Yes
No
What Airline (eg. Delta, United)
Advanced Air
Air Canada
Air France
Alaska Airlines
Allegiant Air
American Airlines
Boutique Air
Breeze
British Airways
Condor
Contour Airlines
Delta Air Lines
Denver Air
Flair Airlines
Frontier Airlines
Great Lakes Airlines
Hawaiian Airlines
JetBlue Airways
Lynx
Porter Airlines
Southwest Airlines
Spirit Airlines
Sun Country Airlines
United Airlines
Volaris
WestJet
Employee
Yes
No
What Employer
Description of Incident (Provide Details)*
Nature and Extent of Injury
Description of Property Damage
Damage To City Property
If damage to City Property was caused by a vehicle, provide insurance policy information here:
Insurance Company Name
Insurance Policy Number
Insurance Company Phone Number
Witnesses
Provide name, address, and phone numbers of ALL witnesses, including persons who inspected place of incident
Reporter Information
If city employee, enter employee ID here to populate details
First Name*
Last Name*
Phone Number*
Title*
Ops Section*
The file must not exceed 10MB in size.
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