Incident Report • CampusOptics

Reporter Info

Email Address* 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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Affiliation with Baylor

Injury Information

First Name

Last Name

Phone Number

Email

Activity Information

Activity

If Other, Please Describe

If Class or Activity Class, Please list Instructor Name

Incident Information

Date and Time of Incident

Description of what happened

What could be done to prevent future incidents

Injury/Illness

Describe the Injury/Illness

First-Aid

Did Police/Fire/EMS respond

Did Police/Fire/EMS treat/transport/refuse transport

Witness 1

First Name

Last Name

Phone Number

Email

Affiliation with Baylor

Witness 2

First Name

Last Name

Phone Number

Email

Affiliation with Baylor

Witness 3

First Name

Last Name

Phone Number

Email

Affiliation with Baylor

Witness 4

First Name

Last Name

Phone Number

Email

Affiliation with Baylor

Property Damage

Describe any property damage that occurred

Supporting Documents (Please include pictures)

Add Supporting Documents

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