Documente Academic
Documente Profesional
Documente Cultură
Use this form to report accidents, injuries, medical situations, or student behavior incidents. (Incidents involving a crime or
traffic incident should be reported directly to the Campus Public Safety office.) If possible, the report should be completed
within 24 hours of the event. Submit completed forms to the President’s Office.
Location of Incident
Beechwood Manor
Description of Incident (what happened, how it happened, factors leading to the event, etc.) Be as specific as possible
(attached additional sheets if necessary)
I entered Mrs. Lawry room to see if she needed any assistance and to invite her to breakfast as Donna stated she came in a
little edgy and confused. As I was helping Mrs. Lawry because I walked in and she was trying to get off the bed, she hit me
with her cane on my left leg
REPORTER INFORMATION
Individual Submitting Report (print name) Tempest Jackson
Signature
Document any follow-up action taken after receipt of the incident report.