Police Incident Report Template

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A police incident report is used to document the facts of a crime before filing an official police report. It’s typically completed by the victim to describe their account of the events and take down important details that might otherwise be forgotten. The report outlines what happened, when and where it occurred, and whether anyone was injured.

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Police Incident Report Template

Last updated September 5th, 2025

A police incident report is used to document the facts of a crime before filing an official police report. It’s typically completed by the victim to describe their account of the events and take down important details that might otherwise be forgotten. The report outlines what happened, when and where it occurred, and whether anyone was injured.

Common Incidents

  • Domestic violence
  • Sexual assault
  • Burglary
  • Motor vehicle theft
  • Vandalism
  • Traffic accidents, including hit-and-run and DUI

Essential Information

The form should record the following information so it can be relayed to law enforcement:

  • Date, time, and location of the incident
  • Names and addresses of the parties involved*
  • Detailed description of what occurred
  • List of any injuries, damages, or stolen property

*It’s helpful to include some form of identification, such as a driver’s license or passport number, to ensure each party involved in the incident is correctly identified.

Sample

Download: PDF, MS Word, ODT

POLICE INCIDENT REPORT FORM

INDIVIDUAL FILING REPORT

Full Name: [FILER NAME] Role in Incident: [ROLE (E.G., VICTIM)]

Signature:                                                               Date: [MM/DD/YYYY]

INCIDENT DETAILS

Date of Incident: [MM/DD/YYYY] Time: [TIME] ☐ AM ☐ PM
Location: [INCIDENT LOCATION]
Incident Type: ☐ Theft ☐ Vandalism ☐ Assult ☐ Traffic Accident ☐ Other: [INCIDENT TYPE]
Describe the Incident: [DESCRIBE INCIDENT]

PARTIES INVOLVED

  1. Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
    Address: [ADDRESS]  
    Identification: ☐ Driver’s License No.: [DL NO.] ☐ Passport No.: [PASSPORT NO.]
    ☐ Other: [OTHER IDENTIFICATION NO.]
  2. Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
    Address: [ADDRESS]  
    Identification: ☐ Driver’s License No.: [DL NO.] ☐ Passport No.: [PASSPORT NO.]
    ☐ Other: [OTHER IDENTIFICATION NUMBER]

INJURIES

Was anyone injured? ☐ Yes ☐ No
If yes, describe the injuries: [DESCRIBE INJURIES]

WITNESSES

Were there witnesses to the incident? ☐ Yes ☐ No
If yes, enter the witnesses’ names and contact info:

  1. Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
  2. Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]

MEDICAL SERVICES

Was medical treatment provided? ☐ Yes ☐ No ☐ Refused
If yes, where was medical treatment provided? ☐ On site ☐ Hospital ☐ Other: [OTHER]