WUST Report Form

WUST Report Form

Purpose: To provide our students, staff, and faculty with a safe and friendly learning environment, WUST has created this form to officially collect, document and investigate any code of conduct violations, including but not limited to unfair treatment, inappropriate behavior, harassment of any kind, injury on school grounds, or any forms of violations against a member of the WUST community or WUST's standards. Those who become aware of an incident or information are encouraged to report it as quickly as possible.
WUST staff will review these reports and coordinate resolutions. WUST makes every effort to protect the rights and privacy of both the complainant and accused until the investigation is complete and WUST Grievance Committee (GC) or relevant investigator makes final deliberation. Incidents should be reported without fears of retaliation or concern for status.

Anonymous Reporting: While anyone may submit an incident report anonymously, doing so may limit our ability to respond to your concern.

Background Information
Your Name Your Name First Last
Your Role

Your Role Staff Student Faculty Other Other
Your Phone # Your Phone # - ### - ### ####
Your Email
Nature of this Report
Approximate Date of Incident Approximate Date of Incident / MM / DD YYYY
Approximate Time of Incident Approximate Time of Incident : HH MM AM/PM
Location(s) of Incident
Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list an SSN or Drivers License number in the block labeled SID if known.

If the name/identity of a person is unknown to you, please enter "Unknown Person" as the name in this section and then describe the individual(s) in as much detail as possible in your narrative. This could include the person's age, sex, physical appearance/characteristics as well as a description of their clothing, accessories, and any distinguishing features or characteristics. You should also identify any known affiliations (school they attend, organization they might belong to, etc.).
Involved Party 1 (Name, Office, or Organization)
Involved Party 1 Role

Involved Party 1 Role Involved in Incident Witness Affected Party
Involved Party 1 ID Number
Involved Party 1 Phone # Involved Party 1 Phone # - ### - ### ####
Involved Party 1 Email
Would you like to add another involved party?
Involved Party 2 (Name, Office, or Organization)
Involved Party 2 Role

Involved Party 2 Role Involved in Incident Witness Affected Party
Involved Party 2 ID Number
Involved Party 2 Phone # Involved Party 2 Phone # - ### - ### ####
Involved Party 2 Email
Would you like to add another involved party?
Involved Party 3 (Name, Office, or Organization)
Involved Party 3 Role

Involved Party 3 Role Involved in Incident Witness Affected Party
Involved Party 3 ID Number
Involved Party 3 Phone # Involved Party 3 Phone # - ### - ### ####
Involved Party 3 Email
Description of Incident

Please address the “wh” questions below in detail:
a. What Happened?
b. Who is/are involved?
c. When happened?
d. How happened?
Please provide a detailed description of the incident/concern using specific concise, objective language. Please provide as much detail as possible in describing the behaviors and activities that occurred. The use of direct quotes, including profanity or abusive language, is encouraged.
Were police contacted?

Were police contacted? Yes No
Was hospital transport required?

Was hospital transport required? Yes No
Was emergency contact notified?

Was emergency contact notified? Yes No
Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.
Upload a File

Attach Files
Resolution
As the complainant what would be an acceptable solution for you?
Select Copy Recipients
If other departments or individuals should receive a copy of this report, please select them below:

If other departments or individuals should receive a copy of this report, please select them below: Academic Department University Administration HR Office Chief of Staff University Compliance Title IX Coordinator Student Services Department