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Incident Reporting Form


Background Information

 
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Email address must be of a valid format.
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Involved Parties

List all of the individuals involved (excluding yourself or other staff members involved), including as many of the listed fields as you can provide. All parties involved should also have specific information about their involvement included in the description/narrative.

For non-students: enter their first and last name (no space) as their ID number, their DOB, and if they are a student at a different university, enter it as their Hall/Address.

Use the following format for DOB (YYYY-MM-DD) and phone number (XXX/XXX-XXXX).

Involved party 1

Incident Narrative

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Was this incident alcohol or drug related? If yes, include specific information in the incident description/narrative.(Required)(Required)
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Were SCSU Public Safety or local law enforcement involved? If yes, include the agency and case number in the incident description/narrative.(Required)
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Was someone transported for alcohol incapacitation or a drug overdose?(Required)
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Was someone transported for other medical reasons (not alcohol incapacitation or drug overdose related)?(Required)
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Was someone transported and booked into jail?(Required)
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Was someone issued a citation by the police?(Required)
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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