Faculty-Led Study Abroad Program Incident Report

The faculty or staff member present at the destination(s) when an incident occurs on any faculty-led program sponsored by Cal State LA must complete this form as soon as possible after the incident. In the event that you need immediate assistance due to an emergency, contact Cal State LA Director of Public Safety Rick Wall at (+1) 323-343-3700.

(Form revised 7-2-2018)

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Complete

Today's Date

Report Created by (Cal State Employee Name)

Employee Email Address

Employee Phone Number

Location of Faculty-Led Program (City and Country)

Location of Incident (City and Country)

Type of Incident

Emergency: Defined as any circumstance that poses a genuine risk to, or that has already disturbed the safety and well-being of trip participants. Examples include disappearance or kidnapping of a participant; criminal assaults against trip participants; sexual assault or rape; serious illness; physical or emotional injury; death; hospitalization for any reason; suicide ideation, threats and attempts; arrest, incarceration or deportation; terrorist threat or attack; local political crisis; or natural disasters such as fires, floods, earthquakes, tsunamis.

Non-emergency

Date of Incident

Time of Incident

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