Incident Reporting Form

To report an issue of immediate concern to an individual’s safety or the campus’s safety, first call 911 or Public Safety at 706-252-4813 and then fill out this report.

Please provide as much detailed information regarding the incident as possible.

Your Background Information

Name

Status

Phone Number

E-mail Address

Incident Description

Please provide a detailed description of the incident, including descriptions of unknown individuals.

Priority

Normal Urgent

Incident Date/Time

Location of the Incident

Specific Location

Did Public Safety respond to the incident?

Yes No

Responding Organization

Involved Parties

Please list the individuals involved, including as much information as possible.

Name

Role

Gender

E-mail

Phone

I have read and agree to the Privacy Policy.