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Brigham Young University - Idaho

University Message

Property Incident Report Form

(For reporting to the University Safety Office)

Reporting Person:    Telephone: 
Department Name:   
Reporting Person's Campus Address:
Type of Incident: 
Date of Incident:
Time of Incident:  
Location: Room Number:    Building Name: 
Location/area outside of a building:

Responsible Party and Phone Number:
Describe what happened in as much detail as possible:
Describe any first aid treatment provided, in detail:
List Full names and phone numbers of individuals who witnessed the incident:
What corrective actions are being taken to prevent it from happening again, if any:

Additional Information, if any:

                                      (Print a copy for your records)