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Incident Report Form
Date/time of incident
*
https://limestonecollege.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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Year
2019
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2029
Hour
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Minute
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AM/PM
AM
PM
Please check the box next to any/all alleged Student Code of Conduct violations. Refer to the Code of Conduct if you are not sure. http://handbook.limestone.edu/student-code-conduct
*
Section 1 - Failure to Comply with Federal, State, Local laws
Section 2 - Cheating
Section 3 - Theft
Section 4 - Physical or Sexual Assault
Section 5 - Alcohol
Section 6 - Drugs
Section 7 - Disorderly Conduct
Section 8 - Unauthorized Entry
Section 9 - Obstruction or disruption of teaching
Section 10 - Failure to Comply with University officials
Section 11 - Quiet Hours / Visitation
Section 12 - Arson
Section 13 - Weapons
Section 14 - Obscenities
Section 15 - Aiding / Abetting
Section 16 - Registration of Parole or Probation Status
Section 17 - Respect for Privacy, misuse of recording or photographic device
Section 18 - Copyright violations
Section 19 - Tobacco
Provide a summary of the incident.
*
Was this report written due to a violation found during a Health and Safety Inspection?
*
Yes
No
How many persons involved in the incident were present other than reporting parties?
*
1
2
3
4
5 or more
Person Involved # 1
Role
*
Student
Resident Advisor
Campus Police
Staff
Faculty
University Administrator
Name
*
First Name
*
Last Name
*
Limestone ID
Date of Birth
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Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
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11
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31
Year
1944
1945
1946
1947
1948
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2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Limestone Email
Person Involved # 2
Role
Complainant / Accuser
Respondent / Accused
Witness
Visitor/Non Student
Other
Name
First Name
Last Name
Limestone ID
Date of Birth
https://limestonecollege.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
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11
12
13
14
15
16
17
18
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20
21
22
23
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25
26
27
28
29
30
31
Year
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Limestone Email
Person Involved # 3
Role
Complainant / Accuser
Respondent / Accused
Witness
Visitor/Non Student
Other
Name
First Name
Last Name
Limestone ID
Date of Birth
https://limestonecollege.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Limestone Email
Person Involved # 4
Role
Complainant / Accuser
Respondent / Accused
Witness
Visitor/Non Student
Other
Name
First Name
Last Name
Limestone ID
Date of Birth
https://limestonecollege.formstack.com/forms/images/2/calendar.png
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Limestone Email
Person reporting incident # 1
Role
*
Complainant / Accuser
Respondent / Accused
Witness
Visitor/Non Student
Other
Name of reporting person
*
First Name
*
Last Name
*
Limestone ID
*
Limestone Email
*
Best Contact Number
Person reporting incident # 2
Role
Student
Resident Advisor
Campus Police
Staff
Faculty
University Administrator
Name of reporting person
First Name
Last Name
Limestone ID
Limestone Email
Best Contact Number
Person reporting incident # 3
Role
Student
Resident Advisor
Campus Police
Staff
Faculty
University Administrator
Name of reporting person
First Name
Last Name
Limestone ID
Limestone Email
Best Contact Number
Person reporting incident # 4
Role
Student
Resident Advisor
Campus Police
Staff
Faculty
University Administrator
Name of reporting person
First Name
Last Name
Limestone ID
Limestone Email
Best Contact Number
Summary of the Incident
1. Evidence - Photo, Video, Screenshots
No File Chosen
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2. Evidence - Photo, Video, Screenshots
No File Chosen
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3. Evidence - Photo, Video, Screenshots
No File Chosen
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4. Evidence - Photo, Video, Screenshots
No File Chosen
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5. Evidence - Photo, Video, Screenshots
No File Chosen
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Finalization of the Incident Report form
For the reporting student: Do you agree that the information above is accurate? If so, please sign below.
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