(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)

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)