SECURITY INCIDENT REPORT

GOLDEN MOON & SILVER STAR
GOLDEN MOON
SILVER STAR
GM Report Log :
  MO. DAY. YEAR TIME
occurred on
or between
and reported
CLASSIFICATION OF REPORT

COMPANY

Counterfeit
Embezzlement
Variance Short/Over
Damage to Property
Loss/Theft of Property
Defrauding an Innkeeper
Robbery
Documents-Checks/C. Cards
Vandalism
Estimated Loss : $

GUEST/PATRON

Complaint
Other
Theft-Coin/Taken
Pick Pocket
Theft-Room
Property Damage
Theft-Other
Lost Property
Purse Snatch
Estimated Loss : $

SAFETY/EMERGENCY

Bomb Threat
Fire Alarm
Fire
Panic Alarm
Hazard
 
Estimated Loss : $

SECURITY

Trespass
Disturbing the Peace
Minors
Arrest
Drugs
Pan-Handling
Assault/Battery
Gaming Violation
Fighting
Disorderly Conduct
Gaming Offense
Estimated Loss : $

Other

Associate Misconduct
Procedure Violation
Associate Complaint
Safekeeping
Associate Violation
Other
Found Property
Estimated Loss : $
PERSONS

Subject

Complainant

Reporting Party

Suspect

Witness

Victim

Associate

Subject

Complainant

Reporting Party

Suspect

Witness

Victim

Associate

INJURY REPORTS
Y
N

PRE-ACCIDENT ACTIVITY

Gambling

How Long

Drinking

How Long Ago

Drinking

How Much

On Medication

When


Other

APPEARANCE/CLOTHING

Ragged/Transient

Business Clothes

Formal Attire

Coat/Jacket

Casual Clothes

Uniform

PRE-INJURY CONDITION

Appeared Sick/Ill

Appeared UICS/Intoxicated

SPEECH

Accent

Stutter

Slurred

Slow

Rapid

Loud

Soft

Not Unusual

SHOES (type)

High Heels

Bare Feet

Flats

Thongs/ Sandals

Slippers

Sneakers

Boots

Spike Heels

BUILD

Thin

medium

Heavy

Muscular

HAIR LENGTH

Over Ears

Varied Length

TEETH

False

Gold Cap

Silver Cap

Own Teeth

Braces

Other

EYES

Normal

Crossed

Contact Lenses

Afflicted Eye

Red

PREMISE

Elevator #

Stairs

Restroom

Hotelroom

Bar Area

Restaurant

Casino

Hotel Lobby

Drive-Ways

OUTSIDE AREA

Stairs

Parking Lot

Parking Garage

Cross Walk

Curb

Restaurant

Ramp

Silver Star

Golden Moon

LIST THE NAMES OF ALL ASSOCIATES ON DUTY AT LOCATION OF INCIDENT
# Name ASSOCIATE NO. DEPARTMENT SHIFT DAYS OFF
1
2
3
4
MISCELLANEOUS INFORMATION
OFFICER’S NARRATIVE
OFFICER’S SIGNATURE:
SIGNATURE OF SUPERVISOR: