UTA Libraries Incident Report Form

This incident reporting form should be used to report behavioral misconduct in the West Library, Central Library, Library Collection Depository, Science and Engineering Library or Nedderman Hall. For immediate assistance, please contact UTA Police 817.272.3003 or dial 9-1-1.

Reporting Party Information
Name Name First Last
Email
Position/ Title
Department
Involved Party
Name of Individual (if applicable) Name of Individual (if applicable) First Last
Select Gender
Individual Email (if applicable)
Individual Phone (if applicable) Individual Phone (if applicable) - ### - ### ####
UTA staff, faculty, student or non related person

UTA staff, faculty, student or non related person UTA Student UTA Staff/ Faculty Member Non UTA related person
To your knowledge, is this their first offense?
If UTA student, staff or faculty member, please provide 1000#
Additional Involved Party

Please use this section to add additional participants
Name of Individual (if applicable) Name of Individual (if applicable) First Last
Select Gender
Individual Email (if applicable)
Individual Phone (if applicable) Individual Phone (if applicable) - ### - ### ####
UTA staff, faculty, student or non related person

UTA staff, faculty, student or non related person UTA Student UTA Staff/ Faculty Member Non UTA related person
To your knowledge, is this their first offense?
If UTA student, staff or faculty member, please provide 1000#
Additional Involved Party

Please use this section to add additional participants
Name of Individual (if applicable) Name of Individual (if applicable) First Last
Select Gender
Individual Email (if applicable)
Individual Phone (if applicable) Individual Phone (if applicable) - ### - ### ####
UTA staff, faculty, student or non related person

UTA staff, faculty, student or non related person UTA Student UTA Staff/ Faculty Member Non UTA related person
To your knowledge, is this their first offense?
If UTA student, staff or faculty member, please provide 1000#
If there are additional participants in the event, please add their name, 1000# and other pertinent contact information here.
Nature of Incident
Incident Time: Incident Time: : HH MM AM/PM
Date Date / MM / DD YYYY
Incident location building
Incident location floor
Please select the incident location
If incident location is not listed above, please list it here with room, room number and floor
Incident Type: Select all that apply.

Incident Type: Select all that apply. Medical- Transport Medical- Physical Injury Threats of Self Harm Threats of Harm to Others Patron Issue Building Access Evacuation/ Fire Alarm Lockdown Shelter Theft Disruptive Behavior Unusual Behavior Drugs Arrest Other Other
If medical transport, please indicate the hospital or emergency room individual was sent to.
Emergency level
Please describe the incident using as much detail as possible, include any specific concerns. Try to focus on the Who, What, When, and How of the incident. If possible try to use specific quotes such as offensive or threatening language. If UTA PD responded to the incident, please include police report number.
Please upload any supporting documents

Attach Files
Action/ Resolution

UTA Police Emergency: 2-3003
UTA Police Non Emergency: 2-3381
Notification: (check all that apply)

Notification: (check all that apply) UTA Police Supervisor Library Organizational Operations
Description of action/ resolution

UTA Libraries Incident Report Form

Reporting Party Information

Involved Party

Additional Involved Party

Additional Involved Party

Nature of Incident

Action/ Resolution