Incident Report Form #TI0005

Fill out all fields in full using a blue ballpoint pen. Submit the top three sheets to your supervisor and retain the bottom (pink) for your records.

Name: -

Employee Number: 0

Supervisor's Name: -

Contact Number: -

Date of Incident (mmddyyyy): -

Supplemental Date Coordinates (xx:yy:zz): -

Who was present for the incident?: P. a. f. k. (3 actors?)

In your own words, please provide a detailed timeline of events. Use additional pages if necessary.

spike anchor pt 1

a, f activity

the usual

3 more spikes anchor pt 3

bg noise increases 2nd spike

a leaves ruins

the usual

P&a meet

massive bg noise increase

k is created? k wakes up? k appears

k stands down

incomplete spike- asymptote line on former peak?

k follows P home

baseline bg noise increases 300% & stabilizes there

possible to map failed spikes to k's behaviour?

activity from f, (activity from a?), multiple spikes choked

k in bad shape after

k lucid

k confirms k as source of choke?

Please supply any additional information about the incident that you feel would be helpful.

no more resets since k started acting?

this sounds like work

Date: -

Signature: s