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.
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 went into Mrs. Lawry’s room when I noticed she was having trouble trying to stand up. When I tried to assist her, Mrs.
Lawry got very anxious and aggravated and yelled “let me do it on my own”, she then hit my leg with her cane.
REPORTER INFORMATION
Individual Submitting Report (print name)
Brandon De La Garrigue
Signature
Brandon D.
Date Report Completed
07/23/2018
Document any follow-up action taken after receipt of the incident report.