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Incident Report Form

Thank you for filling out an incident report. Members, chapters, volunteers and staff have a responsibility to promptly report all incidents where someone was possibly injured, damage occurred, or an incident that could result in campus, community or media attention or an insurance claim. Prompt reporting can often prevent minor incidents from developing into major problems. After filing an incident report and speaking with an Administrative Office staff member, chapters should also report appropriate Risk Management Policy violations to their host campus. In cases of serious bodily injury or death to any member, new member or guest, chapters are required to notify the host institution and the associated public safety department or the local police department.

Names and contact information are requested for the purposes of creating a record. We encourage you to be open and honest with the information you submit. Reports can be filed anonymously by members of the public. In that case, complete the required fields with as much information as you’d like to share. The level of detail Fraternity members and community members provide directly impacts the Fraternity’s ability to respond appropriately to an allegation or claim. To that end, the ideal “Narrative” will include details about individuals

Reports of hazing can also be reported to the Anti-Hazing Hotline at 888-668-4293 (888-NOT-HAZE). Callers may remain anonymous or they can provide personal information so their concerns can be responded to directly.

If you have questions or concerns about this form, whether a form is warranted, or would like guidance on how to best complete the form, please contact the Administrative Office at 800.800.BETA (2382).

Crisis Guidelines and Resources
Crisis Communications Protocol
Fraternity or Community Member Information
Beta Chapter or Campus
Your Full Name*
Your Phone Number*
Your Email Address*
Your Chapter/Community Position
Primary Persons Involved Information
His/Her Full Name*
His/Her Phone Number*
His/Her Email Address*
His/Her Affiliation*
Incident Details/Narrative
Incident Type*
Incident Date*  
Approximate Incident Time*
AM/PM*
Incident Details*
Incident Location*
Was anyone injured?*
If yes, what's the nature of the injury?
First Aid Administered?
Who administered first aid?
Notification of Officials
Type of Official

Beta Staff:
Who did you
notify
Notification
Date
Time
 
Beta Volunteer:
 
Greek Life Official:
 
University Official:
 
Campus Police:
 
City Police:
 
Fire Department:
 
Other:
 
Additional Information
Was the Media Involved?*
What actions has the chapter taken thus far?*
Witness Contact Information
Witness Name
Witness Phone Number
Witness Email Address