SECURE INCIDENT INTAKE

Report an incident

Complete this form as soon as practical. You can attach photos or PDFs and sign from a phone, tablet, or computer.

Emergency? Call 911 first. This form does not contact emergency services.
1Restaurant information
2Potential claim / incident type

Select every option that applies.

3Required follow-up
Was medical attention necessary?

If yes for an employee, a Workers' Compensation report is also required.

Can the cost be recovered from another individual?
Was the total property loss over $2,500?
4Incident details
5What happened
6Corrective action
7Witnesses and manager
8Photos and documents

Add up to 8 JPG, PNG, HEIC, or PDF files. Each file must be 8 MB or smaller; combined files must be 24 MB or smaller.

    9Contact, attestation, and signature

    Before submitting, review the incident reporting privacy notice. It explains how GRO uses, shares, protects, and retains report information.

    Attestation version:
    Draw your signatureUse a finger, mouse, or stylus.
    Ready to submit?

    A signed PDF copy will be stored securely. Nathan will receive a review notice, and the claims mailbox will receive a report copy.

    Saved drafts remain only in this browser for up to 24 hours. Do not save a draft on a shared or public device.

    PRIVACY

    Incident reporting privacy notice

    GRO Restaurant Group, LLC (GRO) uses this form to receive, investigate, and manage reports about incidents involving its restaurants, guests, employees, property, or operations. This form does not contact emergency services. Call 911 first when immediate help is needed.

    Information we collect

    The form may collect the restaurant and location, incident date and time, people involved, incident type, injury or medical-attention details, property loss, witness and manager information, corrective actions, submitter contact information, uploaded photographs or documents, an electronic signature, and the submitter's attestation. GRO's hosting and security providers may also process limited network, browser, and security-verification data needed to deliver and protect the form.

    How we use and share information

    GRO may use the information to respond to and investigate the incident; protect guests, employees, and property; contact submitters or witnesses; manage insurance, workers' compensation, safety, employment, legal, or regulatory matters; preserve evidence; prevent duplicate or abusive submissions; and comply with applicable obligations.

    Access is limited to authorized GRO personnel and designated reviewers with a business need. GRO may share relevant information with insurers, brokers, claims administrators, legal advisers, safety or medical professionals, law enforcement, regulators, and service providers that host or protect the system. An incident report is not posted publicly.

    Service providers and security

    The system uses Microsoft Azure, Microsoft 365/SharePoint, Power Automate, and Cloudflare Turnstile to host, store, route, and protect reports. GRO uses access controls and other reasonable safeguards appropriate to the information, but no system can guarantee absolute security.

    Retention

    Incident and claim records are generally retained for seven years after final closure or final payment, whichever applies and is later. Records may be kept longer when workers' compensation, a minor, an occupational medical or exposure record, an insurer requirement, an investigation, a legal hold, a regulatory obligation, or a dispute requires it. Records are disposed of through an approved secure process when retention is no longer required.

    Local drafts

    If you select Save draft, typed form information is stored only in this browser on this device and automatically expires after 24 hours. Uploaded attachments, the attestation, and a drawn or typed signature are not included in the saved draft. Do not save a draft on a shared or public device. A draft is removed after successful submission.

    Your choices and contact

    Provide information that is accurate to the best of your knowledge and upload only material relevant to the incident. For privacy questions, access or correction requests, or questions about an existing report or claim, email claims@grogc.com. Availability of access, correction, or deletion depends on applicable law and GRO's obligation to preserve claim and investigation records.

    Effective September 4, 2026 · Notice version