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Critical Incident Report Form
Date of Incident
*
+
Place of Incident
Time of Incident if known
Type of Incident
*
Physical assault
Robbery, violent crime, bomb threat
Suicide, attempted suicide
Sudden or unexpected death
Missing student
Domestic violence
Drug or alcohol abuse
Severe verbal or psychological aggression
Physical Intimidation
Other
I wish to remain anonymous:
*
Yes
No
Your name
*
Contact phone number
*
Name of affected person, if different from above:
Is the incident related to the actions of:
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Tabor staff
Tabor student
Other
Not applicable
Description of the Incident/concern:
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Describe actions taken, if any
Any other comments?
Was a Police report filed?
*
Yes
No
What is the report number?
*
Please upload the Police report
Do you want to receive information about what and where you can receive support?
*
Yes
No
Do you want to lodge a formal grievance against someone for their actions?
*
Yes
No
To satisfy the requirements of transparency and natural justice, formal procedures cannot be commenced on the basis of anonymous complaints. Should you wish to proceed, please change your answer about anonymity above.
Would you like a copy of this submission emailed to you?
*
Yes
No
Email address:
*