HULS Incident/Accident Report Form

Complete this form and submit it to your supervisor and to the Director's office immediately following an incident or upon the library's opening the following business day.
1. Date *
2. Last Name *
3. First Name and Middle Initial *
4. HU Affiliation *
5. Primary Phone Number *
6. Alternate Phone Number
7. Email Address *
8. Select One Location
9. Time Incident Occurred *
10. Subject *
11. Description of Event and How it Occurred *
12. What Factors Contributed to the Event? *
13. Action Reccommended or Required *
14. Action Taken *
15. Was Any Person Injured? *
Yes
No
16. If Yes. Describe Injury, Including Parts of the Body
17. Was First Aid Administered? *
Yes
No
18. If Yes, by Whom?
19. Was Campus Police Called? *
Yes
No
20. Time Called
21. Time Arrived
22. Report Number
23. Name of Officer(s)
24. Action Taken
25. Was Metro Police Called? *
Yes
No
26. Time Called
27. Time Arrived
28. Report Number
29. Name of Officer(s)
30. Action Taken
31. Recommendation to Prevent Recurrence
32. Additional comments or explanations