PopCon Incident Report Form

INCIDENT REPORT FORM

Use this form to report accidents, injuries, medical situations, criminal activities, traffic incidents, or fan behavior incidents. The Incident Report Form is crucial for documenting and managing incidents that occur during our events. By providing a detailed record, it aids in effective investigation and resolution of incidents, helping to improve safety protocols and prevent future occurrences. If possible, a report should be completed within 24 hours of the event.

INDIVIDUAL FILING REPORT

First Name

Last Name

Are you Under the Age of 18?

Yes

Phone/Mobile

Have your parents/guardians been contacted?

Yes

Parents/Guardians Name, Contact Phone Number

THE INCIDENT

Date of Incident

Time of Incident

Location of Incident

Describe the Incident

Are there any Images of the Incident?

Yes

Image Upload (Up to 5 Images of 5mb each, PNG or JPG)

Choose File

PERSON(S) INVOLVED

If anyone else was involved, choose/slide number up to 5, otherwise leave at Zero

Person Involved 1 First Name

Person Involved 1 Last Name

Person Involved 1 Phone/Mobile

Person Involved 1 Email

Person Involved 2 First Name

Person Involved 2 Last Name

Person Involved 2 Phone/Mobile

Person Involved 2 Email

Person Involved 3 First Name

Person Involved 3 Last Name

Person Involved 3 Phone/Mobile

Person Involved 3 Email

Person Involved 4 First Name

Person Involved 4 Last Name

Person Involved 4 Phone/Mobile

Person Involved 4 Email

Person Involved 5 First Name

Person Involved 5 Last Name

Person Involved 5 Phone/Mobile

Person Involved 5 Email

WITNESSES

If there were any WITNESSES, choose/slide number up to 5, otherwise leave at Zero

Witness 1 First Name

Witness 1 Last Name

Witness 1 Phone/Mobile

Witness 1 Email

Witness 2 First Name

Witness 2 Last Name

Witness 2 Phone/Mobile

Witness 2 Email

Witness 3 First Name

Witness 3 Last Name

Witness 3 Phone/Mobile

Witness 3 Email

Witness 4 First Name

Witness 4 Last Name

Witness 4 Phone/Mobile

Witness 4 Email

Witness 5 First Name

Witness 5 Last Name

Witness 5 Phone/Mobile

Witness 5 Email

INJURIES

Was anyone physically injured?

Yes

Please Describe the Nature of the Injuries

SERVICES INVOLVED

Was PopCon Security Notfied?

Yes

Was a PopCon Security Report Filed?

Yes

Was ICCLOS Security/Facility Notified?

Yes

Was an ICCLOS Security/Facility Report Filed?

Yes

Was Police Notified?

Yes

Was a Police Report Report Filed?

Yes

Since medical treatment was provided outside/offsite of the convention center, please describe location and details further.

POPCON USE ONLY

PopCon Staff Member Helping Fill Out This Report

Immediate Action Taken

Preventative Measures to Avoid Recurrance

Ownership needs to be involved immediately.

Where should ownership immediately go and/or whom to find?

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INCIDENT REPORT FORM

INDIVIDUAL FILING REPORT

THE INCIDENT

PERSON(S) INVOLVED

WITNESSES

INJURIES

SERVICES INVOLVED

POPCON USE ONLY

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