Incident Report • CampusOptics

Reporter Info

Email* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Exact Location

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Additional Reporter Information

Affiliation with Baylor* Required

If Employee, Position/Title

Incident

Date and time of incident

Description of what happened

What could be done to prevent future incidents

Injury/Illness

Is the injured party the same individual as the reporter?* Required

If No, provide name(s) and contact information for injured individual(s).

Describe the Injury/Illness

First-Aid

Did Police/Fire/EMS respond

If yes, what services did Police/Fire/EMS provide?

Witness 1

First Name

Last Name

Phone Number

Email

Witness 1 Affiliation with Baylor

Witness 2

First Name

Last Name

Phone Number

Email

Witness 2 Affiliation with Baylor

Property Damage

Describe any property damage that occurred

Add Supporting Documents

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