Fillable WEBSTER UNIVERSITY SHORT-TERM FACULTY LED PROGRAM Incident Report (Webster University)

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WEBSTER UNIVERSITY SHORT-TERM FACULTY LED PROGRAM Incident Report (Webster University)

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WEBSTER UNIVERSITY SHORT-TERM FACULTY LED PROGRAM
Incident Report
Program Name:
Faculty Leaders:
Date/Time of Incident:
Location of Incident:
Please select the Type of Incident below:
If Other, Please Describe
Name of Individuals involved in Incident:
Name:
Contact Info:
Name:
Contact Info:
Name:
Contact Info:
Description of Incident (What happened? Who was involved? Witnesses?):
Victim of Crime
Political Situation
Natural Disaster
Medical Emergencies
Criminal Behavior
Behavior Situation
Description of Action Taken:
Was medical attention needed? If so, please indicate any medical facility visited.
Who was contacted at the time of the Incident – local authorities?
Who was contacted at the time of the Incident – university staff?
What is current status of participants? Is Follow-up needed?
Any suggested measures that can be taken to avoid another similar incident?
Form Completed By (Name and Title):
Signature:
Date:
Copies of Incident Report should be distributed to the following:
Required: Office of Study Abroad, College/School Representative, Department Chair
If applicable: Risk Management, Public Safety, Student Affairs
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WEBSTER UNIVERSITY SHORT-TERM FACULTY LED PROGRAM Incident Report (Webster University)

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Completed 2 February 2021

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