Incident Reporting Form
*Edit the fields below according to your needs.
The Other Conduct of Concern Incident Report is available for anyone in the CSUSB community—students, faculty, staff, campus visitors, or guests—who has experienced or witnessed an incident or behavior that needs to be reviewed or resolved.
Submitting this form alerts the Review Team to review the incident report and refer it to the appropriate office for next steps. Including contact information and thorough details about the incident allows us to reach out with resources and support in navigating options. Please visit the CSUSB Other Conduct of Concern site for more information.
The Other Conduct of Concern Incident Report Form is for non-emergency incidents. If you need to report an emergency, call University Police dial 9-1-1.
Concerns regarding allegations of Discrimination, Harassment, and Retaliation as it related to a protected status, as well as Sexual Misconduct, Sexual Harassment, Dating/Domestic Violence, and Stalking should be reported using the Institutional Equity & Compliance Incident Reporting Form
Concerns regarding workplace violence should be reported using the Workplace Violence Reporting Form
Concerns of behavior involving students should be reported using the Student Conduct Incident Reporting Form
Resources:
Employee Assistance Programs
Office of Institutional Equity and Compliance
Title IX Resources
Workplace Violence Prevention Program
Faculty, Staff, Student, MPP, Other.
Complainant: The person who the was the target of the alleged conduct.
Respondent: The person who is alleged to have engaged in the conduct.
Witness: Anyone who saw some or all of the alleged conduct.
You MUST include yourself, including your Coyote ID number and your EMAIL.
Summary of the incident - Please provide all known information regarding the incident as it occurred or was reported to you, including a detailed description of the incident/concern using specific concise, objective language (i.e., who, what, when, where, why, and how).
Please attach any photos, video, email, or other supporting documents.
Attachments require time to upload, so please be patient after submitting this form.