Employee Support & Resources

Catastrophic Leave

Required

Incident Report Submission ID required

This is the ID number at the top of the submission email you received.

What were the consequences of the incident, including, but not limited to: required

Was security or law enforcement contacted and their response: required

Actions taken to protect employees from a continuing threat or any other hazards identified as a result of incident:required

Was the Workplace Violence Prevention Plan reviewed after this incident?required

Yes

No

Was the Workplace Violence Prevention Plan revised due to this incident. If so, how?required

Log completed by: requiredSupervisor's Name

First Name

Last Name

Supervisor's Name

Supervisor's Title: required

Email Addressrequired

Please enter your email to receive a copy of your submission for your records.

Date Completed: required

Must contain a date in M/D/YYYY format