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Incident Report Form

Please note: This form is for University of Arkansas Libraries' internal use only.

Complete this form whenever you need to convey sensitive information about library patrons or incidents involving security, unusual circumstances, or complaints.

Date of Report:
Time of Incident:
Situation:
Describe what happened
When did it take place?
Where did it happen?
Description:
Who was involved?
Participants—include a description of individual(s) if possible:
Witnesses:
Action Taken:
Did you notify Campus Police?
Yes   No
Did you notify anyone else?
Yes   No
If yes, whom did you notify?
Follow-up needed:
Employee Name:
Employee email:
University of Arkansas Libraries
365 N. McIlroy Ave.
Fayetteville, AR 72701-4002
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Phone: 479-575-4104
Toll-free: 866-818-8115
Fax: 479-575-6656

Last updated: 2016-08-29

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