Incident Report Form

Augustana University has an expectation that students, faculty, and staff will share information they receive about campus crime. This form is intended to convey information needed to track the University's response to campus incidents being reported, as well as to assess the danger the incident represents to the community at large. Annual statistical information will be based on this report, as will the need to make timely warnings to the community, for the protection of those who may be at risk.

Fill in all fields that apply. Report only one incident per form. Take more space than is given on this form, as necessary, to complete the descriptions. This form will be submitted to the Title IX Coordinator.

Please indicate your status, Student, Faculty or Staff, Community Member
Submit answer if your status is a faculty or staff member
Parties Involved
Person(s) Involved (Reported to you by):
Was there any evidence that this incident was motivated by the victim"s/complainant"s (select all that apply):
Description of Events (Please provide as much information as possible about the event(s).)
Do you have reason to believe this incident represents a present threat of harm or danger to the victim or other member(s) of the community?
Was a Weapon Involved?