This document is an example of an incident report template. This document is a blank form, and should be filled out by the person reporting the incident. This form includes sections to be filled out, such as what was taking place when the incident occurred; who witnessed the incident, and a description of who the perpetrator is. This document in its draft form contains numerous of the standard clauses commonly used in these types of forms; however, additional language can easily be added. This document can be used by small businesses and is useful to document incidents that occur within the company.