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Reporting Form for Crimes or Incidents


Thank you for reporting an incident and/or sharing your concerns regarding a student or employee at Viterbo University. By sharing your concerns, you are helping to maintain a healthy and safe campus environment.

BEFORE YOU BEGIN: If this is an emergency that involves an imminent risk of harm to self or others, please dial 911 prior to filling out this referral form.

Referrals are reviewed during normal business hours and are not monitored after hours, on weekends, or during official University holidays. While referrals from this form are reviewed by a variety of campus partners working to assist students and employees, it is NOT designed for emergency response situations.

Background Information

 
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I.e. Student, Employee, Faculty, Community Member
Email address must be of a valid format.
This field is required.
This field is required.
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Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. In the block labeled SID (Student ID #), our recommendation for those not affiliated with Viterbo whom you have identified is to use LAST NAME and FIRST NAME, together without spaces (for example: SMITHJOHN). For students, use the last seven digits, starting with 0.

Involved party 1

Questions

This field is required.
Was the incident a sex offense?(Required)
This field is required.
Check the items that were involved in this incident:(Required)
You must make at least one selection.
Was this incident motivated by hate or bias?(Required)
This field is required.
If motivated by hate or bias, identify the category of prejudice:
You must make at least one selection.
Were there any arrests during this incident?(Required)
This field is required.
This field is required.
Were Emergency Medical Services (EMS) called to the incident?(Required)
This field is required.
Did you inform the individual(s) involved that you would be submitting an Incident Report?(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