General Incident Report Form

Background Information

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

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Time value must be standardized and entered in the following format (9:00 AM or 9:00 PM)

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please fill in the information you can provide about all of the individuals involved (including yourself). For non-students, please list a Drivers License or State ID number in the block labeled ZID. If the DL or state ID is from a state other than Illinois, please begin the ID with the state abbreviation. (ex. Wisconsin=WI). For NIU Directory Information, click here.

PLEASE CAPITALIZE THE "Z."

COMMUNITY ADVISORS, STAFF MEMBERS OR FACULTY, WHEN YOU ENTER YOURSELF ON THIS REPORT, YOU MUST USE YOUR A-ID NUMBER.

Name or Organization

Select Role

ZID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

Please provide a detailed description of the incident/concern using specific concise, objective language. Dates and times of incident is also helpful information.(Required) This field is required.

REQUIRED FOR CASES INVOLVING POLICE ONLY: Police CFS Number: This field is required.

Does the victim want police follow up on this matter? (appropriate jurisdiction will be notified: NIU Police for on-campus incidents and City of DeKalb Police for off-campus incidents)(Required)

Yes No

This field is required.

If the victim wants police follow up, please select the best form of communication. (Ensure contact information is provided above.)

Cellular telephone Email In person

This field is required.

As a reporting person, do you want the police to contact you on this matter? (appropriate jurisdiction will follow up: NIU Police for on-campus incidents and City of DeKalb Police for off-campus incidents)(Required)

Yes No

This field is required.

Is this report a resubmission to a previously submitted incident report? (This is designed to replace information on a previously submitted report.)(Required)

Yes No

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.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission