BIT/BICT/CARE Reporting Form

Background Information

Your full name:

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Required

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

building / office / location:

Nature of this report(Required):

This field is required.

Urgency of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list an SSN or Drivers License number in the block labeled SID (Student ID #) if available.

Name

Select Gender

Select Role

900 Number

DOB (YYYY-MM-DD)

Phone number

Email address

optional

Questions

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Background Information

Involved Parties

Questions

Supporting Documentation

Submission