Global Utilities

La Trobe University
Information for Staff

Security incident report

Complete the form and click on the Submit button (below) to lodge your Incident Report. Alternatively, print this page and upon completion, fax or mail it to the address on the left.

 
IR#:
Date of Incident:
Time of Incident:
Nature of Incident:
Location of Incident:
(include type of premises)
Name:
Address:
Phone (Home):
Phone (Work):
Phone (Mobile):
Department:
Staff
Student
Other
Staff/Student Number:
Circumstances of Incident:
Injuries Sustained:
SUSPECT DETAILS
Male
Female
Height:
Hair:
Eyes:
Complexion:
Race:
Other Comments:
WITNESS DETAILS
Name:
Phone:
Security Notified: Yes
No
Police Notified: Yes
No
Police Report being forwarded: Yes
No
Name of Security Officer taking report:
Date of Report taken:
Time of Report taken:

Lodge your Incident Report by clicking on the Submit button below: