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Incident Report Report Information *Person Filing Report *Type of Person Reporting Please select one Resident Assistant Staff Member Resident *UCCS Email Address *Room Number or Location *Date of Incident (mm/dd/yyyy) *Time of Incident Persons Involved PersonMailbox #Phone #Room #ResidentCited/Ticketed Yes No No Yes No Additional People Yes No No Yes No Additional People Yes No No Yes No Additional People Yes No No Yes No Additional People Yes No No Yes No Additional People Yes No No Yes No Additional People Yes No No Yes Type of Incident Type of Incident Alcohol Drugs Assault Noise Fire Theft Trespassing Weapons Medical Transport Suicide Attempt/Threat False Fire Alarm Injury/Illness Psychological Emergency Property Damage Arrested Verbal Abuse Welfare Check Other Type of Incident Reported To: Pro-Staff Member UCCS Police UCCS Counseling Fire Department No Yes Ambulance No Yes Hospital Transport No Hospital Needed Memorial Memorial Briargate Penrose Main Penrose Community Report Description Description Briefly describe the incident, be sure to include any background information that is needed * denotes required field
