Incident Report - Campbell Insurance Agency, Inc. 2025

1. Click ‘Get Form’ to open the Incident Report in the editor.
2. Begin by entering the 'Insured' name at the top of the form. This identifies who is covered under the insurance policy.
3. Fill in the 'Date of Loss' and 'Time' fields to document when the incident occurred.
4. Provide details about the guest involved by filling in their 'Name', 'Telephone', and 'Address'.
5. Complete personal information such as 'S.S. Number', 'Date of Birth', and 'Occupation' for accurate record-keeping.
6. Describe how the accident occurred in the section labeled 'How Accident Occurred/What Caused Accident'. Be as detailed as possible.
7. Indicate how the incident was reported and list any contributing factors that may have played a role.
8. Assess and note the condition of the area where the incident took place, selecting from options like well-lighted, congested, or slippery.
9. Document any injuries that resulted from the incident and specify where medical care was received, including a contact number if applicable.
10. Lastly, ensure that both witness information and guest signatures are completed to validate your report.

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