Incident Documentation Form

If you feel you are in immediate danger of an act of violence or if this is an emergency situation, do not complete this form...Call campus police immediately.

Campus Police
Campus	Phone Number
Knight (Warwick)	825-2109
Flanagan (Lincoln)	333-7035
Liston (Providence)	455-6050
Newport County (Newport)	851-1620

This report will remain confidential and only be shared with members of the Threat Assessment Committee.

Your Information: (* = required)

*Today's Date:

*Name of Person Filing Report:

Title:

Department:

*Campus:

*Best Number To Contact You:

*Email Address:

Incident Details: (* = required)

*Date of Incident:

*Campus Where Incident Occurred:

Name of Person Being Reported:

†CCRI ID #of Person Being Reported:

*Please describe the incident that you wish to report. Please be as clear as possible and stick to observed facts and personal impressions. Do not report things you did not see or hear or make assumptions on others’ impressions.

†Your CCRI ID# is the 8-digit number below your name on your CCRI ID. The number is also known as a banner ID, student ID, or employee ID. If this information is not available, leave this field blank.

Someone from the Threat Assessment Committee will confirm the receipt of this report within 24 hours. Disposition of the incident may take some time thereafter. You will be notified of any actions taken, if necessary, if allowable by law.