Red Flag Incident Report Form

False Reporting: GSU prohibits the filing of knowingly false reports, filling a report out of revenge and/or submitting misleading information. Disciplinary actions will result from actions that violate the CTAT procedure.

  

*Required Field

*Date of Report:

 [None] Select a Date Delete the Date  

*Date of Incident:

 [None] Select a Date Delete the Date  

*Time of Incident:

 
                   

*Location of Incident:

Name of person
you are reporting:

Describe the incident in detail. What was said or done? Who was involved? When? Where? Why? How?

 

Reporting Party Information

 *Last Name:

*First Name:

 Middle Initial: 

Classification:

 
                   

Other: 

 *Primary Phone:

 

 Secondary Phone:

 

 Email Address:

 
This is your __ time reporting this subject.