Red Flag Incident Report Form

False Reporting: GSU prohibits the filing of knowingly false reports, filling a report out of revenge, and/or submitting misleading information. Disciplinary actions will result from actions that violate the CTAT procedure. 

*Required Field 

*Date of Report:	[None]
*Date of Incident:	[None]
*Time of Incident:	A.M. P.M.
*Location of Incident:
Name of person you are reporting:
Describe the incident in detail. What was said or done? Who was involved? When? Where? Why? How?
Reporting Party Information
*Last Name:
*First Name:	Middle Initial:
Classification:	Faculty Staff Student Other           Other:
*Primary Phone:
Secondary Phone:
Email Address:
This is your __ time reporting this subject.	1st 2nd 3rd 4th 5th 6+