Incident Report • CampusOptics

Reporter Info

Email* Required

Phone Number* Required

First Name* Required

Last Name* Required

Campus, Building, or Outdoor Area* Required

Additional Location Details

Exact Location

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Department head name:* Required

Contact name:

Contact phone #:* Required

Contact email address:* Required

Date* Required

Time* Required

OTHER

Describe the property lost / damaged and the causation in detail:* Required

Estimated dollar value of the loss

List all witness names and contact information (including contractors or employees near the location).

Were measures taken to protect the property from further damage? How?

Description of mitigation

Can the damaged property be salvaged in any way to minimize the ultimate loss?

Description of salvage options

Was Facilities Management contacted to inspect and repair the loss? If not, who?

Who completed Inspection and please provide a description of inspection

Did the police, fire or other agency/utility respond to the loss event?

Was a police, fire or other agency report filed? If yes, please provide a copy.

Was there an outside (non-CNU employee) party(s) responsible for the loss?

Responsible party contact information

Is there a contract with the responsible party? If so, provide a copy of the contract.

Was any of the University's proprietary/confidential data or other protected personal information lost or compromised in this event?

Was IT contacted regarding loss of data?

IT contact name:

Add files to upload as supporting documentation along with your incident report.