RADFORD UNIVERSITY
INCIDENT REPORT
| GENERAL | |
| Date/Time of Incident: | Date Reported: |
| Location of Incident: | Dept: |
| Person Filing Report: | Phone: |
| Name of Injured Person: | Phone: |
| Address: | Student_____ Staff_______ Visitor_____ |
| Sex______ DOB______ Age_____ | |
| Name of supervisor: | Phone: |
| NOTIFICATIONS | |
| Was the campus police notified? | Was the Student Health Center notified? |
| Was the rescue squad called? | Was the fire department called? |
| Was the injured person taken to a hospital? | Name of hospital: |
| DESCRIPTION OF INCIDENT: |
| Environmental Conditions: |
| WITNESSES | ||
| Name | Address | Phone |