Incident Report - NON VEHICLE

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  Utah State University
                                      Incident Report - NON VEHICLE

     Today's Date                                Date of Incident                               Time of Incident

Exact Incident Location

Incident Details: Brief Description of Incident.
What Happened?

Continued

Explain USU Involvement

Police Called?                Police Dept                                     Police Report #

Citation Issued?              To Whom? Name                                        What for?

Weather Cond                     Surface Cond                   Other Factors?

Information about Victim (if any):          Victim Name
Victim Complete Home Address                                               Home Phone                      Work Phone

Description of Damages to Property

Describe any Bodily Injury Incurred

Describe Emergency Response

Witness(s):
Witness to incident: (Name, address, Phone)

Witness to incident: (Name, address, Phone)

What do you think caused the incident?
Conditons/Cause of Event

Continued

This Report Completed By:




Submit To:         Utah State University - Risk Management Services 1445 Old Main Hill Logan, UT 84322-1445
                   (435)-797-1844 (435) 797-1825 fax


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