Tarleton Libraries Incident Report Form

Please complete this report for any emergencies, theft, conflicts or other incidents out of the ordinary involving the building, patrons, or staff (For accidents or injuries please use the official university forms). Forward the report to your Supervisor and the Dean of Libraries. The Dean will assign someone to coordinate the official investigation report and summary after this report is filed.

1. PROVIDE THE FACTS. Do not include statements that reflect judgments or opinion.
2. FORMAT. Be concise! Long paragraphs are distracting and unnecessary.
3. KEY ELEMENTS. Answer all the questions: who, what, when, where, why and how.
4. MINDFULNESS. Be mindful of the words you chose and avoid language that could be considered biased or discriminatory.

REPORTED BY:
Your Supervisors Email Address:
DATE, TIME AND PLACE OF INCIDENT:
STAFF MEMBERS PRESENT OR INVOLVED:
LIBRARY PATRONS PRESENT OR INVOLVED (include names addresses and phone numbers):
YOUR ACTIONS/RESPONSE:
PLEASE DESCRIBE THE INCIDENT IN DETAIL (use other side or additional sheets if necessary):
Police Information
Were Police called?

Were Police called? Yes No
If Yes - Name and contact information of Responding Officer:
Police Report Number (if one was assigned):
Medical Assistance information
Was Emergency Medical Assistance Required?

Was Emergency Medical Assistance Required? Yes No
If Yes - Describe

Tarleton Libraries Incident Report Form

Tarleton Libraries Incident Report Form

Police Information

Medical Assistance information