Incident Report Form

In the case of an immediate threat or an emergency, call 911. Complete an incident report form within 24 hours after an incident related to student, employee, or third party misconduct; student, employee, or third party accident or injury; or crime or other safety/security situation, including but not limited to incidents resulting in a 911 emergency call. The purpose of the incident report is for (1) documentation and prevention; and, (2) immediate investigation and response. Incident Report Forms are not complaint forms and a designated employee will confirm receipt of the report and other necessary information via email.

Please contact the Director of Campus Safety and Security at (860) 727-2023 or the Director of Compliance and Title IX Coordinator at (860) 727-6741 with questions about incident reporting.

Reporting Party Information

Individual(s) Involved In The Incident

Individual 1

Individual 2

Individuals (if any) Affected By The Incident/Witnesses

Individual 1

Individual 2

Individual 3

Description of Incident

Factual description of alleged incident (Please describe the incident using facts, observation, and witnesses. AVOID personal judgments and/or feelings and hearsay.

If you have additional supporting evidence/documents please email them to Rich Vibberts at or Megan Monahan at