Provide precise store and product information to establish the foundation for this incident report. Accurate metadata ensures proper routing, trend analysis, and inventory reconciliation.
Store Number
Store Name
Region/District
North America East
North America Central
North America West
Europe North
Europe South
Asia Pacific
Latin America
Middle East & Africa
Country
United States
Canada
United Kingdom
Germany
France
Japan
Australia
Brazil
United Arab Emirates
Other
City
Date and Time of Discovery
Product Category
Electronics & Technology
Jewelry & Watches
Designer Fashion & Accessories
High-End Cosmetics
Premium Spirits & Wine
Pharmaceuticals
Power Tools & Hardware
Luxury Home Goods
Sports Equipment
Other High-Value Items
Brand/Manufacturer
Detailed Item Description
SKU Number
Model or Serial Number
Inventory Location at Time of Incident
Sales Floor - Display
Sales Floor - Stock
Back Stockroom - Secured
Back Stockroom - General
Receiving Area
Warehouse
Transit/Delivery
Customer Hold Area
Other Location
Units Missing/Unaccounted
Total Units in Inventory (at time of discovery)
Supplier/Vendor Name
Is this SKU currently flagged for high-risk monitoring?
Describe the reason for high-risk status:
Has this specific SKU experienced shrinkage incidents in the past 90 days?
How many prior incidents in the past 90 days?
Provide a comprehensive narrative of how the incident was discovered and document all available evidence. Detailed documentation supports investigation, insurance claims, and prevention strategies.
Incident Discovered By
Store Manager
Assistant Manager
Loss Prevention Officer
Inventory Control Staff
Sales Associate
Security Guard
Vendor/Supplier Representative
Customer
Other
Specify other discoverer:
Discovery Method (select all that applied)
Routine Cycle Count
Point-of-Sale Discrepancy
Visual Spot Check
End-of-Day Reconciliation
Auditor Finding
Customer Inquiry
Employee Report
Alarm Trigger
System Alert
Other Method
Incident Classification
External Theft (Shoplifting)
Internal Theft (Employee)
Vendor Fraud
Administrative/Process Error
System Glitch
Damage/Spoilage
Unknown/Undetermined
Organized Retail Crime
Describe suspected shoplifting method and any observed behavior:
Describe evidence pointing to internal theft and employee(s) involved:
Describe vendor fraud method and affected purchase orders:
Describe indicators of organized retail crime activity:
Suspected Method of Removal/Theft
Concealment
Price Tag Switching
Refund Fraud
Sweethearting
Void Transaction Abuse
Direct Grab-and-Run
After-Hours Break-in
Shipment Diversion
System Manipulation
Other Method
Describe the other method:
Was surveillance footage available for the incident area?
Camera IDs covering the incident location
Explain why footage was unavailable (equipment failure, blind spot, etc.):
Footage Review Status
Not Yet Reviewed
Under Review
Reviewed - Evidence Identified
Reviewed - No Evidence
Footage Corrupted/Unusable
No Footage Available
Were there any eyewitnesses to the incident?
Provide witness details and contact information:
Was physical evidence recovered at the scene?
Describe physical evidence (tags, packaging, tools, etc.):
Environmental or System Factors Present (select all that apply)
Power Outage
POS System Malfunction
Network Connectivity Issue
Alarm System Failure
Staffing Shortage
Training Deficiency
Policy Violation
None of the Above
Detailed Incident Description
Estimated Date and Time of Incident (if known)
Duration of Undetected Period
Upload Additional Evidence Documents
Upload Scene Photos or Evidence Images
Calculate the complete financial impact of this incident. Include all cost components and determine necessary inventory adjustments for accurate financial reporting.
Per-Unit Cost Price
Per-Unit Retail Price
Total Cost Value of Loss
Total Retail Value of Loss
Insured Value per Unit (if different from cost)
Does this loss exceed your store's monthly shrinkage threshold?
Monthly shrinkage threshold amount
Impact on Quarterly Inventory Accuracy Target
No Impact
Minor Impact (<1%)
Moderate Impact (1-3%)
Significant Impact (3-5%)
Severe Impact (>5%)
Number of Prior Shrinkage Incidents for this SKU in Last 90 Days
Detailed Loss Breakdown (for multiple items if applicable)
Item Description | Quantity | Unit Cost | Unit Retail | Total Cost Value | Total Retail Value | ||
|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | ||
1 | Sample Item - Replace with actual data | 1 | $100.00 | $250.00 | $100.00 | $250.00 | |
2 | $0.00 | $0.00 | |||||
3 | $0.00 | $0.00 | |||||
4 | $0.00 | $0.00 | |||||
5 | $0.00 | $0.00 | |||||
6 | $0.00 | $0.00 | |||||
7 | $0.00 | $0.00 | |||||
8 | $0.00 | $0.00 | |||||
9 | $0.00 | $0.00 | |||||
10 | $0.00 | $0.00 |
Recommended Inventory Adjustment Action
Immediate Write-Off
Pending Investigation Hold
Adjust in Next Cycle Count
Insurance Claim Recovery
Vendor Chargeback
No Adjustment Required
Additional Financial Impact Notes
Document all external reporting activities. Maintain a complete record of law enforcement engagement and insurance correspondence for legal compliance and recovery efforts.
Has law enforcement been formally notified?
Police Report Number
Explain why law enforcement was not notified:
Police Department/Station Name
Officer Name and Badge Number
Date of Police Report Filed
Has an insurance claim been filed for this loss?
Insurance Company Name
Explain why no claim was filed (e.g., below deductible, self-insured):
Insurance Policy Number
Claim Number
Insurance Deductible Amount
Current Insurance Claim Status
Not Yet Submitted
Submitted - Awaiting Acknowledgment
Under Review
Additional Information Requested
Approved - Awaiting Payment
Partially Approved
Denied
Closed - Paid
Closed - No Payment
Next Insurance Follow-up Date
Has legal counsel been engaged for this incident?
Law Firm/Attorney Name
Additional Authorities or Stakeholders Notified (select all applicable)
Internal Audit Department
Corporate Security
Vendor/Supplier
Payment Card Network (if fraud)
Industry Fraud Database
Board of Directors
No Additional Notifications
Law Enforcement and Insurance Correspondence Log
Final authorization and review by Regional Loss Prevention Director. This section confirms incident validation, approves corrective actions, and establishes accountability for resolution.
Regional Loss Prevention Director Name
Review Date
Director Approval Status
Approved - Proceed with Resolution
Approved with Conditions
Under Further Review
Rejected - Insufficient Evidence
Escalated to Corporate
Director Comments and Assessment
Mandatory Corrective Action Plan
Does this incident require escalation to Corporate Loss Prevention?
Explain escalation rationale:
Are additional security measures recommended for this store?
Recommended Security Enhancements (select all applicable)
Increase CCTV Coverage
Upgrade EAS Antennas
Add Security Personnel
Implement Access Controls
Enhance Employee Screening
Revise Stock Handling Procedures
Increase Audit Frequency
Install Smart Safe
Upgrade Inventory Management System
Regional Loss Prevention Director Digital Signature
Proposed Follow-up Review Date
Additional Executive Notes
To configure an element, select it on the form.