Incident Report Form

* This form is not intended for the reporting of emergency situations that require immediate attention. For an emergency, please call 911.  For non-emergencies, call Campus Safety at (479) 215-5000.

*Required Field


Complete all applicable areas of the report. If you have any questions, please ask a Campus Safety Officer for assistance. Additional narrative space is provided at the bottom of the form. If photos are available, submit as e-mail attachments to When finished, please click the 'Send Report' button to send to Campus Safety.

Location of Occurrence

Time of Occurrence

Victims and Witnesses:

Subjects Involved in Incident

Please describe the subject(s) involved in the incident. For age, height and weight, use a range if needed (ex. 140-160 lbs, 5'05'' - 5'10'').

Subject 1

Subject 2

Vehicle 1

Vehicle 2

Property Involved

Item 1

Item 2

Item 3

Item 4

Summary of Incident

Who, What, When, Where, Why, How

Write a detailed account of what happened. Include background information, if helpful. Do not use pronouns such as 'he, his, they, etc'; instead, use the person's name every time you refer to them.

Campus Safety Officer Receiving and Reviewing Report

For office use only

Please do not fill out the following field: