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Employee Incident Report Form

Complete this form whenever you need to convey sensitive information about library patrons or incidents involving security, unusual circumstances, or complaints. You may also use this form to report a patron's input concerning the libraries' service.

Date of Report:
Time of Incident:

Situation:

Describe what happened

When did it take place?

Where did it happen?

Description:

Who was involved?

Participants—include a description of individual(s) if possible:

Witnesses:

Action Taken:

Did you notify Campus Police? Yes   No
Did you notify anyone else? Yes   No

If yes, whom did you notify?

Follow-up needed:

Employee Name:
Employee email:
Supervisor:
(to whom this email is sent)


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Last modified:
Thursday, November 16, 2006