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Housing Incident Report Form


Resident Assistants and other Housing Staff should use the following report options:

 

-----Housing and Residence Life report for policy violations, injuries, behavior concerns.

-----Housing facilities vomit, urine, or blood for incidents involving vomit or blood.

-----Housing facilities all others for all other facility concerns

-----Training for practice in writing incident reports during training.

If you need access to floor plans of your building, copy and paste the following link into a new window: https://universityofwieauclaire.sharepoint.com/sites/facplanning/Pages/default.aspx

Background Information

 
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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 010 in the block labeled SID.

Involved party 1

Questions

Please provide a detailed description of the incident using specific, concise, objective language in the third person.

Be sure to document specific language and behaviors rather than your opinions or judgments about the person's language and behaviors. In other words, please document precisely what you heard or saw rather than offering your opinion that a person's behavior was rude, for example.

 

If alcohol was involved and alcohol containers are present, please indicate the type, quantity and whether the containers are full, partially full or empty. If a student appears to be under the influence of alcohol or other drugs, please describe the specific signs of intoxication (such as watery, bloodshot eyes; slurred speech; odor of alcoholic beverages; etc.) rather than simply indicating that the student appears to be intoxicated or drunk. If a student admitted to consuming alcohol, please document this information for each student.

 

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Did intoxicating substances appear to be a factor?
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Did a Hall Director from Housing & Residence Life respond?
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Did Campus Police respond?
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Was EMS called?
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If an SA was reported was CASA contacted?
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Did you mark people involved only as witness, victim or alleged? If not go back and change it to one of those three.(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