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Campus Recreation Incident Report

Campus Recreation

Programs
Facilities & Hours
Member Services
About
Contact

Participant Information

Name

ID (if applicable)

Phone

Status

UML Student

Non-UML Student, please list the name of the university

Faculty/Staff

CRC Member

Spectator

Other

Incident Information

Date

Time/minutes

Time/hour

A.M./P.M.

Location

Outdoor Center & Bike Shop

Campus Recreation Center (please list activity area)

Campus Rec Turf Complex

Mini Turf in Front of Rec Center

Cushing Field

Kayak Center/Boathouse

Mahoney Gym

Off Campus (please list)

Riverview Fitness Center

Riverview Studios

South Campus Field/Courts

Tsongas Center

Other

Activity Type

Club Sports (please list which Club)

Free Wheelers

Group Fitness

Instructional/Learn To

Intramural Sports

Kayak/Canoe

Open Recreation

Outdoor Adventure Program

Personal Training

Rental (Please list)

Other

Type of Incident

Campus Rec Complex Unauthorized Use

Complaint

Damaged Equipment

Fight (physical contact)

I.D. Violation

Lost Equipment

Policy Violation

Staff Issue

Theft

Argument

Other

Details of Incident

Fully describe events, actions, and conditions - be complete and specific.

Immediate Action Taken

Did you call Campus Police

Yes

No

Witness

ID # (if applicable)

Phone

Witness

ID # (if applicable)

Phone

Please list name of Campus Recreation Student Supervisor or AT filling out this Report

Date

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