Date-Time of Occurrence
The actual or approximate date/time the event(s) being reported occurred.
Timeline Narrative
Used to detail a time period in which the incident occurred (i.e., between 06/24/2002 @ 9 pm and 06/25/2002 @ 1 am).
Date-Time of Report
The date/time the incident is reported to a Wyoming Downs employee(s) and/or an official report completed.
OTB Location
Select a Wyoming Downs OTB location where the incident occurred or NA.
Location of Incident
Specific area within the OTB location of occurrence.
Incident Classification
Choose the category of incident/offense that best defines the incident being reported.
Summary of Incident
A very short description of incident being reported.
Incident Narrative
A thorough, but concise, explanation of the incident. The narrative should provide answers to the Who, What, Where, When, and Why questions.
Subject First Name
List the first name of the subject being described or “unknown” if it is unknown.
Subject Last Name
List the last name of the individual being described or “unknown” if it is not known.
Subject Middle Name – Initial
List the middle name or middle initial of the individual being described or “unknown” if it is not known.
Select the involvement of the individual being described as related to this incident or “unknown” if it is not known.
Subject Date of Birth
Select the date of birth of the individual being described or “unknown” if it is not known.
Subject Sex
Select the sex of the individual being described or NA if not available or unknown.
Subject Race
Select the race of the individual being described or NA if not available or unknown.
Subject Address -1
List the street number, direction, and street name of the last known address of the individual being described.
Subject Address -2
List any additional pertinent address information (i.e., Unit Number, P.O. Box, etc.).
Subject City
List the city of residence for the individual being described.
Subject Zip
List the zip code for the residence of the individual being described.
Subject State
List the state where the individual being described resides.
Subject Phone
List the phone number for the individual being described.
Subject ID Info
List the identifying number for an item of identification belonging to the individual being described.
Subject ID Type
Select the type of identification listed above belonging to the individual being described.
*** Additional subjects can be listed, if applicable, or NA can be selected to strike the entire section.
Property Information
*** Property can be listed in this section, if applicable, or NA can be selected to strike the entire section.
Property Description
Describe the property applicable to the report.
Property Type
Select the type of property from the drop-down menu.
Property – Qty-Measure
Indicate the number of items or, if applicable, the measure of the item.
Property Value
Indicate the known or estimated value of the property item.
Property Recovered
If the property item was recovered, check this box.
Property Loss
If the property item was lost/damaged, check this box.
Property – Loss Code
Select the appropriate code from the drop-down menu.
Property – Location
Select the appropriate property disposition from the drop-down menu.
Vehicle Information
*** Vehicle information can be listed in this section, if applicable, or NA can be selected to strike the entire section.
The vehicle color can be selected from the drop-down menu or unknown can be selected if the vehicle color is unknown.
Vehicle Year
The vehicle model year can be selected from the drop-down menu or unknown can be selected if the vehicle model year is unknown.
Vehicle Make
The vehicle make can be selected from the drop-down menu or unknown can be selected if the vehicle make is unknown.
Vehicle Model
If known, the model of the vehicle should be listed here.
Vehicle Body Style
If known, the body style of the vehicle should be listed here.
Vehicle Plate Number
If known, the vehicle registration plate number should be listed here.
Vehicle Plate State
If known, the U.S. State issuing the vehicle registration should be listed here.
Vehicle VIN (Vehicle Identification Number)
If known, the VIN of the subject vehicle should be listed here.
Vehicle Insurance Info
If known, the subject vehicle’s insurance information should be listed here.
Vehicle Other Info
Please list any other information regarding the subject vehicle that was not included above.
Police Report Filed
If a report was completed with the applicable law enforcement agency, please tick this box and provide the requested report information.
EMT-911 Called
If a call was placed to emergency services/dispatch, please tick this box.
Notifications
*** In this section, please note the individuals notified as a result of this incident. List the most significant notifications in the three (3) entry fields. If additional notifications need to be listed, please include them in the narrative section of the report.
Notification – Name
List the complete name of the individual notified.
Notification – Contact Number
List the contact telephone number for the individual notified. Usually, a cell phone number is preferred.
Notification – Title-Agency-Identifying No
List the title, agency, and identifying number, if any, for the individual notified.
Reported By Info
*** Please complete this section with the requested information for the individual reporting this incident. The individual reporting this incident to Wyoming Downs should be listed. In the event an employee is the witness/reporting individual, that employee’s information should be listed here.
OTB Site Manager Info
*** The OTB Site Manager for the site where the incident occurred should be included here.
Additional Information
Files may be attached to this report (i.e., digital image, scanned document, etc.) up to 20 MB in size. Larger files may need to be sent to Risk Management separately.