Only use this form if you are reporting an incident that was not recorded in the QRP app because the client site is not tracked with QRP or if you need to provide more details than the QRP app provides.

Scroll the form using the mousepad or trackpad on your laptop or using the touchpad on your mobile device or tablet.

Use this form for submitting detailed incident reports outside of the QRP app or to provide greater details.

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Name *

First

Last

Guard ID Number

Today's Date / Time

Date

Time

Incident Date / Time (if not today)

Date

Time

Assignment *

Client name

Location Address

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Provide the address for the site/incident

Incident Checkpoint/Location *

Where on or near the client site did this incident happen?

Weather Conditions

• Dry, cold
• Dry, hot
• Dry, normal
• Wet, but not raining
• Raining
• Snowing
• Hail
• Windy

Describe Incident *

Describe the incident with as many details as you can recall. This helps RSS management, our clients, and law enforcement.

Contact Information for Law Enforcement Officer(s) — if an agency was called

If law enforcement was called to the site, please provide agency name, officer name, and any contact information for the officer(s) that arrived on the scene

Names and Contact Information of Witnesses

Include this information, if applicable, if not, please type N/A for Not Applicable

Any Other Relevant Information

Please provide any other details that you think will be helpful. If none, please type N/A for Not Applicable.

Upload photos

Click or drag files to this area to upload. You can upload up to 12 files.

Upload photos of the incident site

I have completed this form with accurate details, providing all relevant information to the best of my knowledge. I have not falsified any information. *

• Yes
• No

Submit