A&S - Bias Reporting Form

Incident Reporting Form

If you are in an emergency situation, contact the UC police immediately by dialing 911.The University of Cincinnati values open expression and vigorous debate in the context of civility and mutual respect for diverse individuals and communities. We continually “practice” community by sharing our experiences, listening carefully to others, and debating ideas in civil, generous, and constructive ways. Incidents directly impact our ability to know, trust, support, and learn from one another.

Date and Time of incident*

Location of incident*

Did this incident take place on the Uptown (Clifton) UC campus? *

Did this incident take place on the UC Blue Ash campus? *

Did this incident take place on the UC Clermont campus? *

Describe the incident. If you are making an anonymous report, please provide as many details as possible. *

Please summarize the facts in as much detail as possible. Describe all comments, conduct, gestures, physical injuries, property damage, etc. Identify the person(s) involved in the incident by name, if known, or by physical appearance. List any possible witness(es) by name and contact information, if known.

If you reported this incident to another university department, please include the date you reported it, who you reported it to (department and/or individual), and any response you received. If you did not report it to another department, leave blank.

Do you want to be contacted regarding this report? *

Contact Information

If yes, please provide your contact information below, including name, phone number,
and e-mail address

First Name:

Last Name:

Phone Number:

Email:

Please indicate your affiliation with the University of Cincinnati:

Undergraduate student
Graduate/professional student
Faculty
Staff
Other... This choice will expand a text box

Please know the importance of preserving evidence until a staff person can respond. If you experience or witness a incident, please do the following to document the incident as best you can. If the incident involves a written slur or graffiti, do not erase the text. The police will need to see it. If you have a camera or cell phone camera, take a picture of any evidence, such as physical injury, damaged property, or a license plate. If the incident is verbal, please write down or verbally record exactly what was said – to the best of your recollection and as soon as possible. Retain the contact information of any potential witnesses. Again, please act immediately to preserve evidence; speed and accuracy of response are critical.

(e.g. screenshot of social media post or email)

Incident Reporting Form

Contact Information

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