Incident Reporting Form

Date of incident:
Time of incident:
Exact location (library, floor, room):
Reported to:
Department:

Nature of the offense and brief narrative of the incident:

Description of suspect:
Name:
Sex:  Male, Female
Race:
Age:
Hand:
Build:
Height:
Weight:
Skin:
Eyes:
Hair Color:
Hair Length:
Hair Style:
Facial Hair:

Subject may be located at:

Distinguishing features/ General appearance:

Voice / Speech:

Hat:

Coat / Jacket / Sweater:

Blouse / Shirt:

Skirt / Trousers:

Shoes:

Jewelry:

Additional information / follow-up:

Victim's Name:
Telephone Number:
Address:

UVA Police Contacted:   Yes, No

**This form will be sent via email to the department head and to the Library Administration.