Incident Report • CampusOptics

Reporter Info

Email* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Campus, Building, or Outdoor Area* Required

Additional Location Details

Exact Location

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UNIVERSITY EMPLOYEE INFORMATION

Employee ID W#* Required

Driver License #* Required

Department* Required

Campus Phone* Required

Mail Code* Required

TIME AND PLACE OF ACCIDENT

Date and Time AM/PM* Required

City* Required

State* Required

Police Agency Responding

Police Report #

Were Your Cited?* Required

Wearing Seatbelt?* Required

UNIVERSITY VEHICLE

WSU Vehicle #* Required

License Plate #* Required

Make* Required

Model* Required

VIN #* Required

HOW DID THE ACCIDENT HAPPEN

Detail Explanation of the Accident/Incident* Required

DAMAGE TO UNIVERSITY VEHICLE

Damage to University Vehicle* Required

OTHER DRIVER AND VEHICLE OR PROPERTY INFORMATION

Name of Driver

Address

Phone #

Driver: Make

Driver: Model

Driver: Phone #

Insurance Carrier

Policy #

Vehicle/Property Owner if different from Driver

Driver Cited?

Damage to Vehicle/Property

Authorization

Electronic Signature of Driver* Required

Date of this Report* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your incident report.