Incident Report • CampusOptics

Reporter Info

Email* Required

Phone Number* Required

First Name* Required

Last Name* Required

Campus, Building, or Outdoor Area* Required

Additional Location Details

Exact Location

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Name, Title, Phone number and Email of Reporter* Required

Type of Dangerous Situation* Required

If 'Other', for type of situation, please explain. * Required

Potential Severity of the Situation* Required

Likelihood of Incident Occurring* Required

Was there a near miss situation due to this dangerous situation?* Required

What was the near miss incident related to this dangerous situation? (if not applicable enter N/A)* Required

Immediate actions taken to mitigate situation* Required

Is the dangerous situation currently under control?* Required

Were emergency services contacted? (e.g., 911)* Required

What factors contributed to the dangerous situation?* Required

Add files to upload as supporting documentation along with your incident report.