Baylor University

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Baylor University

Student Incident Reporting Form

Reporter Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Name* Required

Additional Location Details

Exact Location

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Reporter Information

Reporter affiliation with Baylor

Student 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

Physical Conditions

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?

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

Witness 1

First Name

Last Name

Phone Number

Email

Affiliation with Baylor

Witness 2

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.

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