Read The Situation Below and Fill in The Form That Follows.: Homework 1: Accident/Incident Report

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Homework 1: Accident/Incident Report

Read the situation below and fill in the form that follows.

You were on your way to a shopping mall by a car. When you were at the parking lot,
suddenly someone wearing a mask came and tried to snatch your hand bag from behind.
You fought back but the culprit caused a small cut in your arm and fled away with a
motorcycle. You screamed for help but nobody was there. Fortunately, you managed to
remember the number plate and identified the figure of the culprit.

INCIDENT REPORT

(a) Name: _____________________________________________________


(b) Date prepared: ______________________________________________
(c) Location of incident: ___________________________________________
(d) Date/ Time of incident: ________________________________________
(e) Incident case: _______________________________________________
(f) Describe how the incident occurred.

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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(g) Provide the description of the suspect(s).

___________________________________________________________________
___________________________________________________________________
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(h) Did you sustain any injuries? Was there any property loss or damage? Describe the
loss and injuries.

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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(i) Was there any witness or evidence? Please elaborate.

___________________________________________________________________
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