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Police Incident Report
ver1.0.4
PLEASE FILL OUT THE FORM AS COMPLETELY AS POSSIBLE. IF UNKNOWN, LEAVE BLANK.
* Required
Incident Information
TYPE OF INCIDENT
Select Type of Incident
Information Only
Injury-Illness
Fire
Property Damage
Theft-Robbery-Burglary
Assault
Rape
Trespassing
Threats
Harassment
Fraud
Alcohol
Drugs
Disturbance
Other
*Required
Date of Incident (mm/dd/yyyy)
*Required
Time of Incident (appx.)
*Required
Campus
Select Campus
Athens
Palestine
Health Science Center
Terrell
*Required
Location
*Required
Local Public Safety/EMS Agencies Responded
Police
Sheriff
Fire
EMS
Power Company
Water Department
Hazmat
Other
None
Your Name
*Required
Role
Select Role
Faculty
Staff
Administration
Student
*Required
Phone
*Required
Email
*Required
Involved Person 1
Name
Role
Select Role
Student
Faculty
Staff
Administrator
Visitor
Contractor
Status
Select Status
Trespasser
Victim
Suspect
Witness
Race
Select Race
Black
White
Hispanic
Asian
Native Alaskan
Pacific Islander
American Indian
Unknown
Sex
Male
Female
Unknown
Date of Birth
TVIN
Height
Weight
General Description
Slim Build
Medium Build
Heavy Build
Hair Length
Short Hair
Medium Hair
Long Hair
Hair Color
Light Hair
Dark Hair
Grey Hair
Other Distinguishing Features
Person's Address
Person's Phone
Injury/Illness
Taken To Hospital
Yes
No
Arrested
Yes
No
Involved Person 2
Name
Role
Select Role
Student
Faculty
Staff
Administrator
Visitor
Contractor
Status
Select Status
Trespasser
Victim
Suspect
Witness
Race
Select Race
Black
White
Hispanic
Asian
Native Alaskan
Pacific Islander
American Indian
Unknown
Sex
Male
Female
Unknown
Date of Birth
TVIN
Height
Weight
General Description
Slim Build
Medium Build
Heavy Build
Hair Length
Short Hair
Medium Hair
Long Hair
Hair Color
Light Hair
Dark Hair
Grey Hair
Other Distinguishing Features
Person's Address
Person's Phone
Injury/Illness
Taken To Hospital
Yes
No
Arrested
Yes
No
Narrative
Describe the incident as completely as you can. Be sure to add as much detail as possible.
*Information for additional involved people can be added to the Narrative below.
Current date is February 05, 2025
*Required
