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Incident Report Form


If you need to report an emergency, please call 911 or if on campus, the UW-Madison Police Department at (608) 264-2677.

This form is to be completed when reporting incidents of alleged student misconduct, or other information to be reported to staff members in the Office of Student Conduct & Community Standards and/or University Housing. To ensure accuracy and promote a just, responsible, and educational student misconduct process, please complete all fields listed below.

Providing contact information below is optional, unless you are a staff member reporting in your official capacity. If you choose not to provide this information, the form will be submitted anonymously. While we will review all reports we receive, please note that submitting this report anonymously can significantly impede the university’s ability to address the incident and, in most cases, the university will be unable to resolve the incident through the student conduct process.

By submitting this report, you are stating that all information contained in the report is true and correct to the best of your knowledge. Knowingly filing a false report is conduct subject to disciplinary action as defined in UWS Chapter 17 and/or UWS Chapter 18 and may be addressed through the University’s disciplinary process.

Furthermore, please realize that the individuals involved are afforded certain rights under the Family Educational Rights and Privacy Act (FERPA) which established requirements regarding the privacy of student records. Please note that students have the right to inspect and review information submitted regarding this matter, including this report and any supporting documentation.

Background Information

 
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(room #, lot #, intersection, etc., or unknown)

Involved Parties

REMINDER: The misuse of student information available to you in the "People Finder" may be grounds for employment or student disciplinary action.



List all of the individuals involved (excluding yourself or other staff members involved), including as many of the listed fields as you can provide. All parties involved should also have specific information about their involvement included in the description/narrative.



For non-students: enter their first and last name (no space) as their ID number, their DOB, and if they are a student at a different university, enter it as their Hall/Address.



Do not include any dashes in the ID Number, and use the following format for DOB (YYYY-MM-DD) and phone number (XXX/XXX-XXXX).

Involved party 1

Questions

This field is required.
Was this incident alcohol or drug related? If yes, include specific information in the incident description/narrative.(Required)
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Were the police involved? If yes, include the agency and case number in the incident description/narrative.(Required)
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Was someone transported to detox or a hospital for alcohol incapacitation or a drug overdose?(Required)
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Was someone transported to a hospital for other medical reasons (not alcohol incapacitation or drug overdose related)?(Required)
This field is required.
Was someone transported and booked into jail?(Required)
This field is required.
Was a student organization involved in any way based on the information available?(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission