Incident Reporting Form
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Your Name *
If you are a Castor student submitting an anonymous report, write "Anonymous".
Your Organization *
If you are a Castor student, write "Castor".
Your Role/Position/Affiliation *
If you are a Castor student, write "Student".
Date of Incident *
MM
/
DD
/
YYYY
Location of Incident *
Type of Incident
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Please describe the incident in as much detail as possible. Include information on whether this incident is connected to previous incidents involving the same person(s). *
List the full names of all STUDENTS involved in the incident. Write "N/A" if none. *
List the full names of INSTRUCTORS involved in the incident. Write "N/A" if none. *
List the full names of all OTHER CASTOR EMPLOYEES OR AFFILIATES involved in the incident. Write "N/A" if none. *
List the full names of all PEOPLE NOT AFFILIATED WITH CASTOR involved in the incident. Write "N/A" if none. *
Are there any third parties who can attest to the accuracy of this report? 

NOTE: if you are reporting an incident that you were not directly witness to or involved in, you must include at least one person who was directly involved in or was witness to the incident.
 *
If you answered "yes" to the last question, please write the third parties' full names, their organizations & roles, and their contact information.
ATTESTATION: I verify that I have filled out this form accurately, completely, and unbiasedly to the best of my knowledge. (Please enter your full name below. This will constitute your written signature.) *
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