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Incident Reporting Form
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Your Information
This is the contact information for the person filling out this form.
Your name
Leave blank if reporting anonymously. Note that anonymous reports are more difficult for Campus Safety to follow up on.
First
Last
Your affiliation with Taft College
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Faculty
Staff
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Not affiliated with Taft College
Other
Phone
Email
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Address
Street Address
City
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State
ZIP Code
Nature of this report
*
Medical Emergency
Traffic collision
Crime report
General conduct report
Concerning or threatening behavoir
General concern
Urgency of this report
Normal
Critical
Date of incident
*
YYYY dash MM dash DD
Time of incident
Hours
:
Minutes
AM
PM
AM/PM
Location of incident
*
Choose the location closest to where the incident occurred
Administration/Student Services Bldg
Baseball Field
Bookstore
Cafeteria
Center for Independent Living
Child Development Center
Cougar Room
Dental Hygiene
Dorms — Ash Street
Dorms — Cougar
Dorms — TIL
ETEC
G Buildings
Gymnasium
Information Technology Services
Institutional Research
ITEC/Welding
Library
Maintenance & Operations
Parking Lot A
Parking Lot B
Parking Lot C
Parking Lot D
Parking Lot E
Parking Lot, unknown designation
Quad
Science Building
Soccer Field
Softball Field
Student Union
Tech Arts Building
Testing Center
Other off-campus location
Other on-campus location
Specific location of incident
*
Include room numbers if applicable. Be as specific as you can.
Involved Parties
Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list an SSN or Drivers License number in the block labeled "TC A# (or other ID Number)" if available. Use the "+" button at the end of this section to add more involved parties
Involved Parties
Name or Organization (Last, First for names)
Select Gender
Select Role
TC A# (or other ID Number)
DOB
Phone
Email
Address
Actions
Edit
Delete
There are no
Involved Parties.
Add Involved Party
Maximum number of involved parties reached.
Detailed Description
Narrative
Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how).
Questions
What is your relationship with Taft College?
*
TC Student
TC Faculty/Staff
TC Parent
TC Contractor
Other
Has the Taft Police Department been notified?
*
Yes
No
I don't know
Other
What is the primary concern for this report?
Academic
Conduct
Traffic / Parking
Crime
Housing
Medical
Mental Health
Other
Supporting Documentation
File
Photos, .pdf, MS Word, and certain other supporting document types may be attached below. 80 MB maximum total size. Attachments require time to upload, so please be patient after submitting this form.
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, docx, doc, jpeg, xls, xlsx, txt, Max. file size: 80 MB, Max. files: 4.
Name
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