Incident Report Form ONLY USE THIS FORM IF YOU CANNOT ACCESS STARREZ Report Information Person Filing Report: - Select -Resident AssistantStaff MemberResident Type of Person Reporting: UCCS Email Address: Room Number or Location: Date of Incident: Time of Incident: Persons Involved: Person Mailbox # Phone # Room # Resident Cited/Ticketed Operations Person Mailbox # Phone # Room # - None -YesNo Resident - None -YesNo Cited/Ticketed Add more items more items Type of Incident: Alcohol Drugs Assault Noise Fire Theft Trespassing Weapons Medical Transport Suicide Attempt/Threat False Fire Alarm Injury/Illness Psychological Emergency Property Damage Arrested Verbal Abuse Welfare Check Other Type of Incident: Pro-Staff Member: UCCS Police: UCCS Counseling: Please SelectYesNo Fire Department: Please SelectYesNo Ambulance: - None -No Hospital NeededMemorialMemorial BriargatePenrose MainPenrose Community Hospital Transport: Description: Briefly describe the incident, be sure to include any background information that is needed