Incident Report Form

NOTE: This form automatically goes to the Director of the library chosen below. The report should also be sent to your supervisor and to others in the library who need to be aware of the situation immediately.

Concerning which library: (Required)

Art Library
Ekstrom Library
Kornhauser Health Sciences Library
Music Library
University Archives & Records Center

Also send to:

Enter complete email address. Multiple addresses may be listed separated by commas.

Person Reporting the Incident

Name: (Required)

E-Mail: (Required)

About the Suspect (if applicable)

Sex: (Required)

Male
Female

Age:

Height:

Weight:

Race:

Hair color

Eye color:

Clothing:

Describe in detail: coat/jacket, shirt/blouse, trousers/jeans/shorts, shoes, hat, tie, decorations, watch, jewelry,etc.

Anything else:

Glasses, scars, tattoos, speech impediment, odd walk, limp, etc.

About the Patron (if applicable)

Was a library patron involved? (Required)

Yes
No

Name of patron:

Address of patron:

Patron's e-mail:

Patron will receive a copy of this report if e-mail is entered.

Patron's phone number:

Comments from patron:

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Incident Report Form

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