Report #: _______________
Classification:
Security will designate a Report # & Classification after your submittal
UH HILO INCIDENT REPORT FORM
The University of Hawaii at Hilo has an expectation that employees and students will share information they have or
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.
Instructions: Fill in all fields that apply. Rep
ort only one incident per form. Take more space than is given on this
form, as necessary, to complete the descriptions. You should return this form to a University Security Officer within 24
hours of becoming aware of an incident. You may also email this form to
uhhsafe@hawaii.edu.
Your name: Position/Department:
Phone:
E-mail:
Reported to you by : victim witness third-party anonymous
Date of report: Date of incident: Time of incident:
Location of incident:
If you wish to avoid specifics regarding the location, please indicate one of the following
(Please call Security for definition of these categories (932-7013):
On campus Residence Hall Public Property Off campus Other
State Type of Incident and describe the incident in as much detail as possible:
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?
Yes
No
If Yes, why?
Was a weapon involved? Yes No
Was a Maxient Report Filed?
If a single assailant/perp,
describe:
Role of assailant/perp(s) on
campus:
Name of alleged assailant(s):*
Gender: Race: Age: Height: Weight:
Student Staff Faculty No campus role Unknown
