Incident Report

This form should be utilized for all occurrences in recreation facilities that result in behavior incidents.

All injury based occurrences should be documented utilizing the accident report.

Person Filing Report
Position of Person Filing Report:
Date of Incident Date of Incident / MM / DD YYYY
Time of Incident: Time of Incident: : HH MM AM/PM
Location Where Incident Occurred:
Building or Field Name
Type of Activity During Incident

Type of Activity During Incident Open Recreation Intramural Sports Club Sports League Fitness Class Rental
Specific Sport or Activity
Name of Person Involved in Incident:
SU/ESF ID NUMBER of person involved in incident:
If non SU/ESF, write non- affiliate
Additional Names of Persons Involved in Incident:
Include SU ID Number
If Minor, Date of Birth If Minor, Date of Birth / MM / DD YYYY
Team Name if applicable
Witness Contact Information:
Nature of Incident

Nature of Incident Eligibility Harassment Fight Equipment Theft ID Card Abuse Theft of Personal Items Complaint Other Other
Description of Incident:
DPS Notified?
Name of Responding Officer:
Name of Professional Staff Notified:
Time Professional Staff Notified: Time Professional Staff Notified: : HH MM AM/PM
Spam Protection. Please answer this simple question:
5, 6, 7, 8 : the 2nd number is?