Capital University

Incident Report

Incident Reports must be objective, including the facts of the incident as observed/witnessed during the incident.  All incident reports must be submitted immediately following the incident to the Office of Residence Life via your Residence Hall Coordinator.

PDF Version is here.

Date of Incident: Actual Time of Incident: AM PM

TYPE OF INCIDENT
Abusive Conduct Medical Emergency Sales & Solicitation
Alcohol Mental Health/Psychological Sexual Assault
Belligerence Noise/Courtesy Hours Theft
Break Housing/Early Arrivals Non-Compliance Trash
Drug Occupancy Vandalism
Fighting/Physical Assault Pets Visitation/Guests
Fire Safety Prohibited Items Furniture
Roommate Conflict Human Dignity Policy Safety & Security
Other -
Location of Incident: Room Number:
Capital Apartments Cotterman Schaaf
Capital Commons Saylor-Ackerman SS/Lohman Complex
College Avenue Other -

The following persons are being documented for the incident:

Individuals Being Documented Student ID Address Cell Phone Number
1.
2.
3.
4.
5.
6.
7.
8.

The following staff responded to the incident:

Name Title Address Cell Phone Number
1.
2.
3.
4.
5.
6.
7.

The following persons were witnesses to the incident:

Name of Witness Student ID Address Cell Phone Number
1.
2.
3.
4.

Was Public Safety involved? Yes No
If Yes Name of Officer(s)

Summary of Incident

THIS REPORT IS BEING FILED BY THE FOLLOWING:

Name Building Cell Phone Number Signature
1.  
2.  
3.  
4.  

 

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Capital University
1 College and Main, Columbus, OH 43209-2394
614-236-6011

Kimberly M. Ferguson
Associate Dean of Students/Director
kfergus2@capital.edu

Student Rights & Standards
1 College and Main
Columbus, Ohio 43209-2394
Local: (614) 236-6611
Fax: (614) 236 - 6971