Accident / Incident Report Form
Use this form to report accidents, injuries, medical situations, criminal activities, traffic incidents, or student behavior incidents. If possible, a report should be completed within 24 hours of the event.
Date of Report
/
Month
/
Day
Year
Date
1. Person Involved
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Identification:
Driver's License:
Passport:
Other
Identification Number:
EX: Driver's License No
2. The Incident
Date of Incident
/
Month
/
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location:
Please Select
San Marcos
Describe the Incident:
3. Injuries
Was anyone injured?
Yes
No
Other
If yes, describe the injuries:
4. Witnesses
Were there witnesses to the incident?
Yes
No
Other
If yes, enter the witnesses' names and contact information:
5. Police / Medical Services
Were the police notified?
Yes
No
Other
If yes, was a report filed?
Yes
No
Report Number:
Was medical treatment provided?
Yes
No
Refused
If yes, where was medical treatment provided?
On site
Hospital
Other
Please give a detailed description:
6. Person Filing Report
Name
First Name
Last Name
Location:
Please Select
0005 - San Marcos
Submit
Should be Empty: