105 Internal Incident Review Report

Date:

Facility/District:

Incident Location:



Type of Incident:



Time and date of incident:


Offenders Involved:
Name:


IDOC#:


Name:


IDOC#:


Name:


IDOC#:


 (Add additional rows if necessary)
Staff Involved:
Name:


Associate #:


Name:


Associate #:


Name:


Associate #:


 (Add additional rows if necessary)
Others Involved:
Name:


Name:


Name:


 (Add additional rows if necessary)
What department policies, SOPs, FMs, post orders, living guides, etc. govern the incident?




Were policies, SOPs, FMs, post orders, living guides, etc. followed?




Did staff members respond properly?




What, if anything, can be done to reduce the risk of a similar incident in the future?



Results, findings, and recommendations on the following:
Staffing:




Policy and SOP:




Operational Issues:




Training:




Equipment Issues:




Other:





Signatures:

Panel member Associate # Date

Panel member Associate # Date

Panel member Associate # Date