Incident Reporting Form

Background Information

Ferris State University is an equal opportunity institution. For information on the University’s Policy on Non-Discrimination, visit ferris.edu/non-discrimination.

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Your full name:

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Please note that our follow-up abilities are limited with anonymous reports.

Your position/title:

Your email address:

Email address must be of a valid format.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

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For incidents that happen outside, please choose the nearest location

Specific location:

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(room number, parking lot number, etc.)

Involved Parties

Please list the individuals involved, including as many of the listed fields as you can provide.

Do not list yourself or other staff members in this section. There is a space near the end of this page to list other responding staff members.

Roles:

Respondent - Student who may have violated policy

Victim/Affected Party- Student directly affected by the respondent's actions

Witness - Students who have first hand knowledge of the incident but are not alleged to have violated policy

Non-Student - Not a student at Ferris State University. Please list first and last name.

Name

Select Role

Student ID Number

Hall & Room Number

Questions

This section is used to explain the details of the incident.

Here are a few reminders:

- Number (e.g., 1, 2, 3,…) each individual sentence and start each sentence on a new line

- Start the report with the date, time and location of the incident. All reports should start like this: "On day, date, at time,..." and then address how the incident was discovered. “While on rounds”, or “RA _____ received a call” etc.

- Use full names only the first time you reference an individual

- Subsequent references should be by last name only along with an identifier (RA Smith, Resident Potter, etc.)

- Be brief and concise yet descriptive

- Use short sentences

- Only identify facts, NOT impressions; what you actually witnessed, NOT what you believed

- Avoid pronouns (I, you, he, she, it, we, us)

- Describe it, don’t just name it (The radio in the room was turned up and could be heard 10 doors down. vs. It was really loud)

- Use appropriate language; grammar and spelling ARE IMPORTANT!

- Use actual quotes with quote marks when possible; do not quote if you don’t remember exactly what was said

- Write the report in chronological order of events

- Reread your summary as if you were not there

- All reports not following these guidelines will be returned to the author for rewriting.

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how):(Required) This field is required.

Were campus police present during this incident?(Required)

Yes No

This field is required.

Please list first and last names of other staff members who responded: This field is required.

Supporting Documentation

Attach additional information as needed. 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