Exhibit A Unusual Incident Report (1).docx

This document is an Unusual Incident Report Form template issued by the State of Arizona as part of a solicitation process. The form is designated as Exhibit A and serves as a standardized reporting mechanism for agencies participating in the state contract award. The document provides a template format for agencies to document and report unusual incidents within one business day of occurrence.

The form requires agencies to complete mandatory fields including agency name, program designation, date of incident, participant and staff information, incident classification, detailed description of the incident, identification of observers, immediate actions taken, and submitter information with date of submission. This reporting mechanism appears designed to ensure standardized documentation and prompt notification of unusual incidents across state and local contract operations, with the complete solicitation requirements available on the Arizona government portal at https://app.az.gov (Page 74 of 101). No specific pricing terms, goods, services, option periods, or financial amounts are detailed in this form template document.