Incident Report Form Header Image

Incident Report Form

Fill out this form to notify Risk Management of any incidents that may develop into a claim.

Your Information

Your Name*
Your Status*
Type "N/A" if not applicable.
Phone Options*
Please check a box next to the type of phone number you want to leave. You may select one or both.
What is your connection to the Incident?
Your Address*
Your Date of Birth*

Incident Location

The Incident took place at*
Another Location - Address
Please add any additional information about the Location of the Incident you think will be helpful.

Incident Information

Date And Time Of Incident*
:  
Incident Type*
Please check all that apply.
Please describe the Incident in as much detail as possible.

Party Information

Please enter the number of parties (Injured Party, Property Owner, Witness) for which you have information.

Party 1

Party 1 Name*
Party Type1*
Party 1 Address
Party 1 Gender

Party 2

Party 2 Name*
Party 2 Type*
Party 2 Address
Party 2 Gender

Party 3

Party 3 Name*
Party 3 Type*
Party 3 Address
Party 3 Gender

Party 4

Party 4 Name*
Party 4 Type*
Party 4 Address
Party 4 Gender

Party 5

Party 5 Name*
Party 5 Type*
Party 5 Address
Party 5 Gender

Property Information

If this Incident involves the loss or damage of property, please download the linked document below and attach it to this form:

Property Information Form

If you do not have access to Excel, please contact Risk Management at rmassistant@biola.edu for a Google Sheets version.

Property Information Form
No File Chosen
File uploads may not work on some mobile devices.
Please upload the Property Information Form here.

Vehicle Information

If this Incident involves vehicles, please download the following:

Vehicle Information Form

This form is quite long, so please scroll the spreadsheet to the righ and be as detailed as possible. If you do not have accses to Excel, please contact Risk Management at rmassistant@biola.edu for a Google Sheets version.

 

Vehicle Information Form
No File Chosen
File uploads may not work on some mobile devices.
Please upload the Vehicle Information Form here.

Pictures & Documents

Please upload any pictures or documents related to this Incident.

File 1
No File Chosen
File uploads may not work on some mobile devices.
File 2
No File Chosen
File uploads may not work on some mobile devices.
File 3
No File Chosen
File uploads may not work on some mobile devices.
File 4
No File Chosen
File uploads may not work on some mobile devices.
File 5
No File Chosen
File uploads may not work on some mobile devices.
File 6
No File Chosen
File uploads may not work on some mobile devices.
File 7
No File Chosen
File uploads may not work on some mobile devices.
File 8
No File Chosen
File uploads may not work on some mobile devices.
File 9
No File Chosen
File uploads may not work on some mobile devices.
File 10
No File Chosen
File uploads may not work on some mobile devices.

Comments & Signature

Electronic Signature*