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3
Guidelines for using your Serving It Right Logbook
An Incident Logbook is your record of the details surrounding an incident involving a patron. It gives an accurate and measurable picture of what happened in the event that:
• A patron was denied entry, refused or cut off from service, or required transportation home;
• An injury or accident occurred on your premise;
• A minor was present on your premise;
• Emergency personnel were called (police, fire, or ambulance).
A detailed, accurate incident logbook is a strong element of any defense should an incident lead to legal action against your business. It will be used by police, lawyers, and the courts.
Records must be kept for at least six years. In most instances a person’s right to sue for an incident in an establishment ends after two years. However, there are various circumstances when a legal proceeding may be commenced against an establishment several years after the incident.
Completing the Daily Communications Log
The Daily Communications Log should be completed every day even if nothing happened. It is a method of due diligence to help you and your staff record and recall events that occur on your premise on a daily basis. Each day, the staff member who completed the daily entry should sign his or her name.
When a Yes is circled an Incident Report MUST be completed and the Incident Report # cross referenced in the Daily Entry. A separate Incident Report must be completed for every Yes that is circled, even if more than one is circled on the same day.
Completing an Incident Report
An accurate and complete log, together with sales slips, may form the backbone of your defense in civil litigation and in enforcement hearings before the liquor authority.
As soon as an incident has been taken care of a manager or licensee must:
• Complete an Incident Report from Section 2.
• Record the Incident Report # on the Daily Communications Entry (Section 1) for the date of the incident.
• Attach all sales records associated with the incident to the Incident Report.
If the incident may lead to legal action a manager should notify the insurer. Staff should always be debriefed after an incident. This is an opportunity to assess and improve procedures and house policies to avoid a repeat of the incident.
4
INCIDENT REPORT SAMPLE
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
April 3, 2016 11:29
Tina S October 15, 1963
5’ 7”
170 lbs.
None
Reddish Brown
2345
4
Pink top, black velvet jacket, black pants n/a
Alice T
Jennifer R and Robert B
Robert B Steve H
Jennifer R
5
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
Robert B. offered a free taxi home
Acme Cabs
Shane J
123 Main St., Vancouver, BC V0V 0V0
604-555-5555
At 10:30 pm Tina S and Alice T entered the establishment and ordered
appetizers and one bottle of wine with a 12% alcohol volume. At 11:20 Tina attempted
to order a second bottle of wine, but was refused service by Jennifer R . Tina
asked to speak with the manager and Jennifer asked Robert B to come to speak
with the ladies. Robert also refused service and offered Tina and Alice a free taxi ride
home. This offer was accepted and Tina and Alice left the establishment at 11:37 pmin an Acme taxi.
Robert B
Jennifer R
Robert B
Server
Manager
Maureen S
567 First St., Vancouver, BC V1V 1V1
778-555-5555
6
DAILY COMMUNICATION LOG ENTRY January 1
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 2
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 3
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 4
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
7
DAILY COMMUNICATION LOG ENTRY January 5
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 6
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 7
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 8
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
8
DAILY COMMUNICATION LOG ENTRY January 9
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 10
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 11
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 12
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
9
DAILY COMMUNICATION LOG ENTRY January 13
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 14
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 15
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 16
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
10
DAILY COMMUNICATION LOG ENTRY January 17
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 18
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 19
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 20
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
11
DAILY COMMUNICATION LOG ENTRY January 21
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 22
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 23
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 24
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
12
DAILY COMMUNICATION LOG ENTRY January 25
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 26
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 27
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 28
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
13
DAILY COMMUNICATION LOG ENTRY January 29
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 30
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY January 31
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 1
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
14
DAILY COMMUNICATION LOG ENTRY February 2
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 3
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 4
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 5
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
15
DAILY COMMUNICATION LOG ENTRY February 6
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 7
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 8
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 9
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
16
DAILY COMMUNICATION LOG ENTRY February 10
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 11
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 12
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 13
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
17
DAILY COMMUNICATION LOG ENTRY February 14
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 15
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 16
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 17
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
18
DAILY COMMUNICATION LOG ENTRY February 18
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 19
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 20
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 21
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
19
DAILY COMMUNICATION LOG ENTRY February 22
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 23
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 24
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 25
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
20
DAILY COMMUNICATION LOG ENTRY February 26
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 27
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY February 28
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 1
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
21
DAILY COMMUNICATION LOG ENTRY March 2
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 3
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 4
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 5
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
22
DAILY COMMUNICATION LOG ENTRY March 6
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 7
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 8
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 9
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
23
DAILY COMMUNICATION LOG ENTRY March 10
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 11
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 12
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 13
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
24
DAILY COMMUNICATION LOG ENTRY March 14
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 15
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 16
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 17
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
25
DAILY COMMUNICATION LOG ENTRY March 18
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 19
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 20
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 21
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
26
DAILY COMMUNICATION LOG ENTRY March 22
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 23
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 24
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 25
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
27
DAILY COMMUNICATION LOG ENTRY March 26
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 27
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 28
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 29
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
28
DAILY COMMUNICATION LOG ENTRY March 30
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY March 31
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 1
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 2
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
29
DAILY COMMUNICATION LOG ENTRY April 3
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 4
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 5
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 6
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
30
DAILY COMMUNICATION LOG ENTRY April 7
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 8
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 9
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 10
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
31
DAILY COMMUNICATION LOG ENTRY April 11
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 12
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 13
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 14
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
32
DAILY COMMUNICATION LOG ENTRY April 15
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 16
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 17
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 18
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
33
DAILY COMMUNICATION LOG ENTRY April 19
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 20
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 21
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 22
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
34
DAILY COMMUNICATION LOG ENTRY April 23
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 24
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 25
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 26
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
35
DAILY COMMUNICATION LOG ENTRY April 27
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 28
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 29
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY April 30
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
36
DAILY COMMUNICATION LOG ENTRY May 1
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 2
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 3
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 4
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
37
DAILY COMMUNICATION LOG ENTRY May 5
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 6
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 7
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 8
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
38
DAILY COMMUNICATION LOG ENTRY May 9
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 10
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 11
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 12
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
39
DAILY COMMUNICATION LOG ENTRY May 13
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 14
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 15
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 16
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
40
DAILY COMMUNICATION LOG ENTRY May 17
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 18
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 19
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 20
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
41
DAILY COMMUNICATION LOG ENTRY May 21
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 22
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 23
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 24
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
42
DAILY COMMUNICATION LOG ENTRY May 25
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 26
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 27
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 28
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
43
DAILY COMMUNICATION LOG ENTRY May 29
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 30
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY May 31
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 1
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
44
DAILY COMMUNICATION LOG ENTRY June 2
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 3
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 4
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 5
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
45
DAILY COMMUNICATION LOG ENTRY June 6
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 7
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 8
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 9
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
46
DAILY COMMUNICATION LOG ENTRY June 10
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 11
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 12
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 13
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
47
DAILY COMMUNICATION LOG ENTRY June 14
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 15
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 16
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 17
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
48
DAILY COMMUNICATION LOG ENTRY June 18
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 19
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 20
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 21
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
49
DAILY COMMUNICATION LOG ENTRY June 22
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 23
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 24
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 25
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
50
DAILY COMMUNICATION LOG ENTRY June 26
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 27
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 28
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
DAILY COMMUNICATION LOG ENTRY June 29
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
51
DAILY COMMUNICATION LOG ENTRY June 30
Completed by:
Did any staff member: Incident Report #
Deny entry: Yes / No
Refuse/cut off service: Yes / No Was there:
Remove an intoxicated patron: Yes / No An injury or accident: Yes / No
Arrange transportation for a patron: Yes / No A minor on premise: Yes / No
If Yes to any of the above an Incident Report
must be completed.
Were police, fire, or ambulance called? Yes / No
52
INCIDENT REPORT #01
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
53
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
54
INCIDENT REPORT #02
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
55
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
56
INCIDENT REPORT #03
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
57
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
58
INCIDENT REPORT #04
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
59
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
60
INCIDENT REPORT #05
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
61
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
62
INCIDENT REPORT #06
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
63
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
64
INCIDENT REPORT #07
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
65
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
66
INCIDENT REPORT #08
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
67
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
68
INCIDENT REPORT #09
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
69
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
70
INCIDENT REPORT #10
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
71
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
72
INCIDENT REPORT #11
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
73
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
74
INCIDENT REPORT #12
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
75
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
76
INCIDENT REPORT #13
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
77
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
78
INCIDENT REPORT #14
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
79
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
80
INCIDENT REPORT #15
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
81
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
82
INCIDENT REPORT #16
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
83
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
84
INCIDENT REPORT #17
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
85
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
86
INCIDENT REPORT #18
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
87
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
88
INCIDENT REPORT #19
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
89
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
90
INCIDENT REPORT #20
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
91
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
92
INCIDENT REPORT #21
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
93
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
94
INCIDENT REPORT #22
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
95
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
96
INCIDENT REPORT #23
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
97
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
98
INCIDENT REPORT #24
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
99
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
100
INCIDENT REPORT #25
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
101
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
102
INCIDENT REPORT #26
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
103
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
104
INCIDENT REPORT #27
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
105
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
106
INCIDENT REPORT #28
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
107
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
108
INCIDENT REPORT #29
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
109
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
110
INCIDENT REPORT #30
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
111
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
112
INCIDENT REPORT #31
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
113
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
114
INCIDENT REPORT #32
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
115
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
116
INCIDENT REPORT #33
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
117
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
118
INCIDENT REPORT #34
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
119
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
120
INCIDENT REPORT #35
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
121
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
122
INCIDENT REPORT #36
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
123
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
124
INCIDENT REPORT #37
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
125
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
126
INCIDENT REPORT #38
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
127
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
128
INCIDENT REPORT #39
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
129
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
130
INCIDENT REPORT #40
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
131
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
132
INCIDENT REPORT #41
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
133
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
134
INCIDENT REPORT #42
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
135
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
136
INCIDENT REPORT #43
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
137
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
138
INCIDENT REPORT #44
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
139
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
140
INCIDENT REPORT #45
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
141
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
142
INCIDENT REPORT #46
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
143
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
144
INCIDENT REPORT #47
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
145
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
146
INCIDENT REPORT #48
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
147
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
148
INCIDENT REPORT #49
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
149
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
150
INCIDENT REPORT #50
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
151
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
152
INCIDENT REPORT #51
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
153
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
154
INCIDENT REPORT #52
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
155
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
156
INCIDENT REPORT #53
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
157
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
158
INCIDENT REPORT #54
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
159
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
160
INCIDENT REPORT #55
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
161
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
162
INCIDENT REPORT #56
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
163
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
164
INCIDENT REPORT #57
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
165
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
166
INCIDENT REPORT #58
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
167
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
168
INCIDENT REPORT #59
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
169
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
170
INCIDENT REPORT #60
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
171
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
INCIDENT REPORT #
Date: Time incident occurred: am / pm
Weather: Sun / Clouds / Wet / Dry / Snow / Wind
Customer details
Name: Sex: Male / Female Birth date:
Age: 19-25 / 26-30 / 31-35 / 36-40 / 41-49 / 50-59 / 60-65 / 66+ Height:
Weight: Eye colour: Blue / Brown / Green / Grey / Unknown Glasses: Yes / No
Facial hair: Moustache / Beard / Goatee / Other:
Hair colour: Blonde / Brown / Black / Grey / Other:
Hair length: Short / Mid / Long Details:
Clothes: Other:
Was the person alone? Yes / No / Don’t know If no, name of person they were with?
Were staff familiar with the patron and/or accompanying patrons? Yes / No / Don’t know
Why/how were they familiar?
Denial of entry
Reason: Intoxicated / Minor / Troublesome / Dress code / No ID / False ID / Previously barred / Other:
Refusal of service / Removal from premises
Reason: Intoxicated / Troublesome / Minor / Other: Number of drinks consumed on premises:
What was the patron drinking? Beer / Wine / Spirits / Fortified wine / Other:
Were all of the patron’s receipts retained? Yes / No Receipt numbers:
Names of all staff who served patron:
Refusal by whom? Was the patron removed from the premises? Yes / No
Names of all staff involved in removal:
Did all staff removing the patron possess security certificates? Yes / No
Injury / accident
What part of the body was affected?
Was medical attention given? Yes / No If yes, by whom?
Was hospitalization required? Yes / No How did the patron contribute to their injury?
If trip or fall, condition of the floor and any foreign substances detected:
Are photos available of the area? Yes / No
Minor on premises
Was the minor caught drinking alcohol? Yes / No If yes, who gave the minor a drink?
Was ID checked? Yes / No If yes, by whom?
If yes, indicate type of ID: BC Services Card / Driver’s License / BCID / Passport / Military ID / Other:
Transportation
Were alternate methods of transportation offered? Yes / No If yes, specify:
How did the patron leave the premises? Taxi (company: ) / Friend on premises
Friend from home / Walking / Car / Motorcycle / Bicycle / Boat / Police / Other:
If the patron drove home in their own vehicle please specify: License plate number:
Province/State: Colour: Make:
Police
Time of call: am / pm
Time of patron’s departure: am / pm Time of officer’s arrival: am / pm
Name of officer(s): Badge number(s):
Witnesses (if possible obtain for at least 2 witnesses)
Witness #1 name: Witness #2 name:
Address: Address:
Telephone: Telephone:
Detailed description of incident (include documentation on how much alcohol was served; recommend attaching copy of staff schedule for that day)
All appropriate steps have been taken: Yes / No All evidence has been retained: Yes / No
Manager notified: Yes / No If yes, name of manager:
Video surveillance available? Yes / No Bar Watch / TreoScope information available? Yes / No
Insurance company / broker contacted? Yes / No Date contacted:
We, the undersigned affirm that all the information recorded herein is factual, accurate and complete regarding the circumstances surrounding the incident.
Print name: Signature: Position:
Print name: Signature: Position:
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