(Please read the instructions before filling this form out)

Incident Report
* = Required Field

* Nature of Incident (check all that apply, describe below):









Description of perpetrator, if applicable:









Other description or distinguishing features:
* Description of incident (to be completed by victim/witness, when possible; include anything the perpetrator said or did; LISTS of facts are preferred to NARRATIVE description):
Have there been previous incidents involving this person? (If yes, describe).
Person reporting incident:

* Status:
Responding Officer/Party (if applicable)
Witness(es):

The University Libraries thanks you for taking the time to complete this form. If additional details come to mind, please do not hesitate to amend your responses.

Send me a copy also? Email:
(Enter only one email address – You may forward the copy to additional persons in your mail program)