Incident Report - University of Rochester Traveler Abroad

To be completed by University of Rochester program/organization leaders or individual travelers.

This form provides a uniform procedure for documenting the (Who, What, When, Where) of reportable student/traveler incidents and crimes.

Complete this form thoroughly for any crimes or incidents (including hospitalizations, serious/major illness, alcohol violations, robberies, assaults, etc.) affecting any UR student, faculty, or staff member on sponsored or supported travel abroad.

If you are a student seeking assistance related to an incident of sexual misconduct and do not want to make a formal report about the incident to the University, please review your options for seeking support and making an anonymous report on the Student Sexual Misconduct website here.

If this is an ongoing emergency, immediately contact the University's Director of Global Travel Risk Management for resource support:

Director of Global Travel Risk Management

24/7 Cell: +1 585-857-1168 (iMessage, WhatsApp, Viber)

WeChat ID: URtravelManager

Email: travelsecurity@rochester.edu

For additional support, please contact Public Safety or the Emergency Preparedness Manager:

UR Public Safety

+1 585-275-3333

Emergency Preparedness Manager
24/7 Cell: +1 585-353-4700

Email: dbujak@safety.rochester.edu

Country *

Program Name *

Name of Person Submitting Report * 🛈

Email *

Contact Number (Cell Phone, WhatsApp, WeChat, Viber, etc.) *

Number of UR Students/Travelers Involved *

Name of Student/Traveler (1) * 🛈

Name of Student/Traveler (2) * 🛈

Name of Student/Traveler (3) * 🛈

Name of Student/Traveler (4) * 🛈

Name of Student/Traveler (5) * 🛈

Date of Incident/Crime * +

Local Time of Incident/Crime * 🛈

*

AM

PM

Location of Incident/Crime *

Were there witnesses? *

Yes

No

Unknown

Who were the witnesses? *

Description of Incident/Crime *

Immediate action taken by UR Program Leader or first responders *

Were clinic/hospital/health practitioners consulted? *

Yes

No

Name of clinic/hospital/health practitioner *

Was there medical treatment required? *

Yes

No

Please include a brief description of the medical treatment *

Were host university authorities notified? *

Yes

No

N/A

Who was notified? *

Was the local police notified? *

Yes

No

Unknown

Was a report filed? *

Yes

No

Report Number

Are you already in communication with a University of Rochester faculty or staff member?

Yes

No

Please provide name and email of University of Rochester faculty or staff member.

Contributing factors, if known, such as weather, student’s own behavior, failure to follow UR policies, failure to follow Program Leader advice, political situation, etc. 🛈

Additional Comments

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