PUBSAFE INCIDENT REPORT

Please complete this form whenever the ShopSafe CCTV Radio is used.
If a manager/doorstaff is on duty please inform them to deal with the incident.

Name of Staff member who used radio to CCTV:

Venue of Incident:

Incident Severity:
In accordance with our incident management process, Please indicate the severity of this incident and who should be alerted.

Reason for use: (Describe individual involved and why it was required to alert behaviour/incident to police).

Duty Of Care: Was the person involved drinking alcohol on the premises? If yes please list estimated consumption.

Date of incident:
Time of incident:

Police attendance?
(If yes - please list name/badge number of officers involved.)

Was anyone injured or anything damaged?
(If yes please list injuries or broken items).

Was this incident reported to a manager?