Real Estate Agent Liability Incident Report
Date of Incident
Time of Incident
Location of Incident
Name of Agent Involved
Agent Contact Information
Parties Involved (Other Than Agent)
Description of Incident
Witnesses (Name & Contact Information)
Actions Taken Immediately After Incident
Injuries or Property Damage
Reported To (e.g., Police, Broker)
Report Reference Number
Additional Comments
Report Completed By
Date Completed