Theta Tau Incident Report Form

This form should be used to share information on incidents. The following types of incidents should be reported:violations of Theta Tau's Constitution,

violations of Theta Tau's PPM (including the H&S Policy),
violations of the law,
violations of the university policy,
incidents resulting in injury, regardless of how minor

Incidents should be reported as soon as possible, preferably within 48 hours.

In all cases, a call to the chapter's Regional Director is expected.

Reporters may remain anonymous but are asked to provide an email address for follow up.

** Please note that submissions may be viewed by members of staff who are not initiated members of Theta Tau. Specifics regarding ritual should not be included.**

If you would like to communicate immediately with a member of our staff, you can call or text Jennifer Kreiman, Director of Chapter Services, at 512-326-1270. Information shared during conversations/text messages will remain confidential. Questions regarding incident reporting can be directed to Director Kreiman via email at Jennifer.Kreiman@ThetaTau.org.

Please verify that you are human*

Name of Person Completing this Form (Reporter)

First NameLast Name

Email of Reporter

example@example.com

Cell Phone of Reporter

Please enter a valid phone number.

Date Incident Occurred*

Date

Chapter/University at which the Incident Occurred*

Did the incident occur in a chapter house?*

YesNoI don't knowOther

Nature of Incident*

Please describe what happened.*

Please list any members/alumni/potential new members involved. Please include contact information if available.*

Please list any witnesses to the incident. Please include contact information if available.*

Has the university been notified?*

YesNoI don't knowOther

Has law enforcement been notified?*

YesNoI don't knowOther

Were emergency services needed?*

YesNoI don't knowOther

Please add any documentation on this incident

Is there anything else we should know?