Incident Report

Incident Report

If you experience or witness an act that violates the rules and regulations mandated by Waldorf University, please document each instance by using the Incident Report form below. Submit all reports to either the Residence Hall Director, the Director of Residence Life or the Dean of Students within 24 hours of the incident.
Name*

First NameLast Name
Title
Local Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email
Phone Number

Area CodePhone Number
Type of Incident: (check all that apply) *Actions(motivated by hate, discrimination or bias against a victim's disability, ethnicity, gender, national origin, race, religion, sex, or sexual orientation*

Alcohol-relatedDamage/VandalismDisorderly ConductDrug-relatedEmotional DistressFacilities/EquipmentFailure to ComplyFire Equipment/AlarmIllness/InjuryHarassment/BullyingHate Based*Misuse of ElectronicsNoise/Quiet HoursPhysical AssaultSexual AssultSexual HarassmentHarrassment/StalkingTheftUnauthorized EntryVerbal Assault/ThreatsVisitation/EscortWeaponsOther
Other: (please explain)
Date of incident

MonthDayYear
Date
Time of incident

Hour Minutes

AM/PM Option
Is this a recurring incident?*
Incident occurred:*

On-campus, in student housingOn-campus, not in student housingOff-campus
Specific location of incident: (building, room, area, etc.)*
Specific student housing location:*
Persons involved: (list all persons involved/witnesses as necessary, include name, role, address and if they're a non-student)
Were police involved?*
Was campus security involved?*
Were person(s) involved informed that an incident report would be submitted?
Description of incident: (be as complete as possible-list additional persons involved/witnesses and contact information as necessary)*
Please attach a file if you have any documents, photos or images that will help us with this issue.

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