Alcohol Incident Report Form printable pdf download

Alcohol Incident Report Form

ALCOHOL INCIDENT REPORT

ALL employees and customers involved or witnessing the incident need to fill out a separate report and

document in their own words what they saw and what happened.

Attach a copy of guest check to the report made by the specific server or bartender involved.

Guest’s name: _______________________________________________ (If possible)

Your name: __________________________________

Contact Info _____________________

You are an (circle one)

Employee

Customer

Date of incident:_____/_____/_____

Time of incident:______ am / pm

Type of incident (Check one)

Refused Alcohol Service based on:

Apparent intoxication/physical impairment. What signs made you come to this conclusion? Ex. slurring,

change in behavior, loss of balance, aggressive, etc.

___________________________

Was this person served alcohol by you or in the establishment? YES

If the answer is yes:

How many drinks were served? ____________ Over what period of time? _______________

What type of drinks were served? __________________________________________________

Was food offered or served to this person? YES

If the answer is yes:

What time was the food offered/served? ____________

What food was served? _____________________________________________________________

Person was providing alcohol to a minor

Was the minor able to consume any alcohol?

If so, how much do you think they were provided ________________________________________________

Provided alternate transportation (Yes / No) If yes, complete one of the following

Alcohol Incident Report Form