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Incident notification form
Notifier's details
First name notifier
*
Surname prefix
Surname notifier
*
Employee number
Phone notifier
*
E-mail notifier
*
Incident location
Faculty / unit
*
Academy Building
Archaeology
Faculty Governance and Global Affairs
Gravensteen
Housing Office (SOZ)
Humanities
ICT Shared Service Centre (ISSC)
Law
Management and administration
Plexus (SOZ)
Real Estate Directorate
Science
Social and Behavioural Sciences
University Library
University Services Department (UFB)
University Sports Centre (USC)
Other
Please specify "other"
Institute / department
*
Building / room number
*
Incident type
Incident type
*
Accident (with hospitalization)
Accident (other)
Hazardous situation
Security and threatening situation
Inappropriate behavior
Other
Are you the victim yourself?
*
Yes
No
Victim's details
Name
Surname prefix
Surname
E-mail
Institute / department / company
Phone
Incident's details
Date
dd/mm/yyyy
Time
Description of event (including actions
already taken)
*
Is the Automated External Defillibrator
(AED) used?
Yes
no
*
= Input is required