HTML Preview Student Incident page number 1.
PROCEDURE
1. Make sure the student is safe and receiving medical attention if necessary.
2. Contact the Host University or your in-country contact about the incident.
3. Gather information about the incident.
4. Contact the TAMIU Police Department at 001-956-326-2911. (UPD is available 24 hours a day/ 7 days a week)
REPORT INFORMATION
Faculty Member Making Report:
Contact Number:
Email:
Responding Host Institution/ In-country Coordinator:
Program Name:
Date of Report:
STUDENTS INVOLVED
Student Name:
Student ID Number:
Student Name:
Student ID Number:
Student Name:
Student ID Number:
Current location/status of student(s) involved in the incident:
____________________________________________________________________________________________
Name of individual currently with the student(s) if not the faculty member:
Relationship of this individual to the study abroad program:
Contact information for this individual:
CRITICAL INCIDENT BACKGROUND INFORMATION
Location (include city and country):
Date of Incident: Time: Place to Contact:
Individual to Contact:
Nature of Incident:
____ Injury (specify): ________________
____ Death in Family
____ Hospitalization
____ Stalking
____ Drug/Alcohol Overdose
____ Infectious Disease
____ Riot
____Sexual Assault
____ Physical Assault/Mugging
____ Hostage
____ Natural Disaster
____ Suicide/Attempt
____ Accidental Death
____ Missing Student
____ Mental Health Crisis
____ Other: _________________________
Details of Incident: On a separate paper, describe what happened. Limit your observations to facts. Be sure to include witnesses,
emergency personnel contacted, who helped with the situation, anyone else affected by the incident, student
injuries, etc.
FOLLOW-UP INFORMATION
Be sure to maintain written record of the incident and the steps taken to address it. If the issue is being handled by several people,
please include who is responsible for what.
ACKNOWLEDGEMENT
___ During the course of my program no incidents were reported to me.
_________________________________________ _____________
Faculty Signature Date
STUDENT INCIDENT REPORT