Incident Form

Use the OJC Incident Form to report any activity or individual that demonstrates disruptive behavior, personal struggles, mental and/or emotional instability, or other behavior that causes other members of the OJC community to feel distress.

Do You Wish to remain Anonymous?    
First Name:   If Anonymous Not Required
Last Name:   If Anonymous Not Required
Your EMail Address:   If Anonymous Not Required
Retype Your EMail Address:   If Anonymous Not Required
Contact Phone:   If Anonymous Not Required

Who are You?

I am (a)   *Required Field

About the Issue Involved in the Incident

How would you categorize the incident?   *Required Field
Where did incident take place?
(Provide a room number or specific location if possible.)
  *Required Field
Date the incident occurred?
(Example: 04/14/2014)
  *Required Field

Your Details About the Incident

Please explain your concern, incident, complaint or grievance in the box below. Include any Students, Faculty, or Staff that were involved in this incident. Please be as descriptive as possible. This will help us determine the course of action.
Briefly describe the details of the incident:
  *Required Field