Incident Report Form : Michael Schwartz Library, Cleveland State University

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Incident Report Form

Library users may use this form to report any unusual incident or event in the Michael Schwartz Library, such as a situation involving library staff, other library users, or personal security.

*Indicates required fields.

Please supply the following information:

Your Name :

Date of Incident:

Time of Incident:

Location of Incident:

* Describe exactly what happened (please be specific):
*You must begin with the word NOSPAM for your form to be sent

Describe exactly what action was taken by Library personnel :

Suggestion to prevent the situation from reoccurring :

Did you notify Campus Police?

Yes

Police Report Number:

Did you notify anyone else?

Yes

If so, whom did you notify?

Would you like to be notified of any follow-up action?

Yes

Contact Information (optional)

Fill out the information below only if you want to be notified of any follow-up action.
Otherwise go to the end of the form and submit.

How would you prefer to be contacted?

Your email address :

Please retype your email address again:

Work Phone (include area code)

Home Phone (include area code):

What is the best time to reach you?

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Michael Schwartz Library
Cleveland State University
We bring people & information together.
(216) 687-2479
Rhodes Tower
2121 Euclid Avenue
Cleveland, Ohio 44115-2214

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