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Incident/Accident Reporting Form


Please provide detailed information regarding the observed behavior of concern or incident involving Felician College student(s). In completing this form, you will be asked to provide your name and contact information. Once the report is received, a designated staff member will follow up with the report and address the incident. Please be aware that you and the identified other person(s) may be contacted to provide further information and/or assistance. Action taken as a result of this report may be protected by federal privacy law (Family Education Rights and Privacy Act) and therefore will be considered confidential information.

This incident report is ONLY to report Felician College related incidents. Questions regarding the filing of this form can be directed to the Vice President for Student Affairs at (201) 559 - 3564.

Background Information

 
Email address must be of a valid format.
This field is required.
This field is required.
This field is required.
This field is required.

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 Drivers License number in the block labeled SID (Student ID #) if available.

Involved party 1

Questions

This field is required.
This field is required.
Was there a personal injury?(Required)
This field is required.
Was an EMT called?(Required)
This field is required.
Was the Fire Department called?(Required)
This field is required.
Was the individual transported to the hospital?(Required)
This field is required.
Were Lodi police called?(Required)
This field is required.
Were Rutherford police called?(Required)
This field is required.

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.

Submission