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Incident Report
Incident Report
Full Name
Department
Address
Status
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Faculty
Staff
Student
Administration
Guest
Phone
Email
Date and Time of Incident
Date and Time of Incident: Date
Date and Time of Incident: Time
This was a drill
Yes
No
Incident Type
Incident Type
- Select -
Bomb Threat
Campus Violence
Equipment Malfunction
Fire
Injury
Property Damage
Property Theft
Tornado / Weather
Other…
Enter other…
Please describe the incident as completely as possible. Include names and contact information for witnesses if available.
Were emergency services required?
yes
no
Was first aid provided?
Yes
No
Did personnel respond appropriately?
Yes
No
Was communication effective?
Yes
No
Was evacuation required?
Yes
No
If required, was it accomplished in an orderly and timely manner?
Yes
No
Was an audible or visible alert triggered?
Yes
No
Was a text alert received?
Yes
No
Do you need additional follow up from a TCAT member regarding this incident?
Yes
No
Leave this field blank
