This report will be distributed to [list the parties to whom the report will be distributed, e.g., management, safety and health department, etc.].
While at the Futa Restroom, Emily and her daughter were using the facilities. The incident involved [insert details here, e.g., an accident, an altercation, a complaint about the facilities].
On [Insert Date] at approximately [Insert Time], an incident occurred involving Emily, Emily's daughter, and the facilities at the Futa Restroom. The purpose of this report is to document the details of the incident in a factual and professional manner.
This report is considered confidential and should only be shared on a need-to-know basis.