UMES Incident Response Form
This form is to be used by UMES event attendees and volunteers in the instances that they are the victim and/or witness of an incident.

It is HIGHLY encouraged that individuals complete this incident response form as soon as possible (if the situation permits) so UMES can respond promptly. Response times to incident reports will vary from 8-24 hours.

In the case that the incident involves criminal activity and/or individuals requiring immediate medical attention and/or other time sensitive emergencies, please make sure to follow up with public emergency services by dialing #555 (for on-campus events) OR 911.

Disclaimer - UMES has limited control over the actions of patrons outside of official UMES events and can not be held liable for these external incidents, however the UMES Incident Response Committee will attempt to follow up on all reported incidents on a best efforts basis.

Full Legal Name
Providing your name is OPTIONAL - you can choose to remain anonymous.
Your answer
Contact Information
Providing your contact information is OPTIONAL - you can choose to remain anonymous. However, providing contact information will often assist UMES in responding effectively to these incidents. Further by providing contact information, you allow a representative from UMES to contact you if further follow up is required. Relevant contact information includes one (or both) of the following: Student Email Address, Phone Number
Your answer
Date of Incident *
MM
/
DD
/
YYYY
Time of Incident *
Time
:
Location of Incident *
Relevant locations include, but is not limited to: Business Name, Address, Building No., Room No., City/Town
Your answer
Description of Incident *
This description should include any events leading to or immediately following the incident.
Your answer
Name and Role of Parties Involved *
If you can NOT provide a full name(s), please include any relevant details regarding the parties involved (e.g. partial name, physical description, affiliation). Include ALL parties that are directly involved in the incident. An example answer to this question is as follows: "John Smith - Group Volunteer".
Your answer
Name and Role of Witnesses
If you can NOT provide a full name(s), please include any relevant details regarding the parties involved (e.g. partial name, physical description, affiliation). Include ALL parties that are directly involved in the incident. An example answer to this question is as follows: "John Smith - Group Volunteer".
Your answer
Have you already reported the incident to anyone else? *
If you have already reported the incident, please indicate the parties you reported to.
Your answer
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