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Incident Types
Reporting Persons
Involved Contacts
Incident
Vehicles Involved
Property
Digital Media
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Requestor's IP Address : 3.235.76.155
Select Report Type
Please select the report type:
Original or Supplemental.
Select
Report Type
Definition
Original
This is the first report you have filed for this incident.
Supplemental
You are adding information to a
previous report
which was
submitted online
.
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Original Online Report Number:
Select Incident Type(s)
Select
Incident Type
Definition
Examples
Building / Maintenance Issue
any issues or defects of the physical building or equipment not functioning
room too hot, electrical plugs not working ETC...
Safety Concern
any and all concerns for safety
trip hazards, guards removed from equipment ETC...
Slip / Fall
any fall or incident in loss of traction by a student or employee
snow and ice related falls, slipping on wet floor
Select Reporting Person Type
Please select a proper person type according to the definition below.
Select
Person Type
Definition
Individual
If you are reporting this for yourself.
Business
If you are responsible for reporting this for your employer or your own business.
Enter Reporting Person Information
Please enter your information as completely as possible. You may be contacted regarding this incident. An email address is required if you would like to be notified when this report is received and approved.
Person Type:
FACULTY
FEDERAL AGENT / OFFICER
FIRST RESPONDER
INJURED / ILL PERSON
LOCAL AGENT / OFFICER
PARENT
PERSON OF INTEREST
POSSIBLY INJURED
REPORTING PERSON
STAFF
STATE AGENT/OFFICER
STUDENT
SUSPECT
VEHICLE OWNER
VICTIM
WITNESS
Employee ID:
First Name:
Middle Name:
Last Name:
Home Address:
City
 /
State
 /
Zip Code:
 /
Country
 ,
 ,
,
Home Phone:
Mobile Phone:
Email Address:
Email report to this address
Confirm Email:
Employer Name:
Work Address:
City
 /
State
 /
Zip Code:
/
Country
 ,
 ,
,
Work Phone:
Race:
A - ASIAN
AI - AMERICAN INDIAN
B - BLACK
FACULTY
H - HISPANIC
M - MULTIRACIAL - BLACK AND AMERICAN INDIAN
M - MULTIRACIAL - BLACK AND ASIAN
M - MULTIRACIAL - BLACK AND HISPANIC
M - MULTIRACIAL - BLACK AND PACIFIC ISLANDER
M - MULTIRACIAL - HISPANIC AND ASIAN
M - MULTIRACIAL - HISPANIC AND PACIFIC ISLANDER
M - MULTIRACIAL - UNKNOWN
M - MULTIRACIAL - WHITE AND AMERICAN INDIAN
M - MULTIRACIAL - WHITE AND ASIAN
M - MULTIRACIAL - WHITE AND BLACK
M - MULTIRACIAL - WHITE AND HISPANIC
M - MULTIRACIAL - WHITE AND PACIFIC ISLANDER
N/A
OTHER
P - PACIFIC ISLANDER
STAFF
STUDENT
U - UNKNOWN
W - WHITE
Sex:
F
FEMALE
M
MALE
N
DOB:
Driver License Number:
Licensing State:
Person Type
Name
Home Phone
Mobile Phone
Work Phone
Enter Involved Contact Information
Please enter your information as completely as possible. You may be contacted regarding this incident. An email address is required if you would like to be notified when this report is received and approved.
Person Type:
FACULTY
FEDERAL AGENT / OFFICER
FIRST RESPONDER
INJURED / ILL PERSON
LOCAL AGENT / OFFICER
PARENT
PERSON OF INTEREST
POSSIBLY INJURED
REPORTING PERSON
STAFF
STATE AGENT/OFFICER
STUDENT
SUSPECT
VEHICLE OWNER
VICTIM
WITNESS
Employee ID:
First Name:
Middle Name:
Last Name:
Home Address:
City
 /
State
 /
Zip Code:
/
Country
 ,
 ,
,
Home Phone:
Mobile Phone:
Email Address:
  
Email report to this address
Confirm Email:
Race:
A - ASIAN
AI - AMERICAN INDIAN
B - BLACK
FACULTY
H - HISPANIC
M - MULTIRACIAL - BLACK AND AMERICAN INDIAN
M - MULTIRACIAL - BLACK AND ASIAN
M - MULTIRACIAL - BLACK AND HISPANIC
M - MULTIRACIAL - BLACK AND PACIFIC ISLANDER
M - MULTIRACIAL - HISPANIC AND ASIAN
M - MULTIRACIAL - HISPANIC AND PACIFIC ISLANDER
M - MULTIRACIAL - UNKNOWN
M - MULTIRACIAL - WHITE AND AMERICAN INDIAN
M - MULTIRACIAL - WHITE AND ASIAN
M - MULTIRACIAL - WHITE AND BLACK
M - MULTIRACIAL - WHITE AND HISPANIC
M - MULTIRACIAL - WHITE AND PACIFIC ISLANDER
N/A
OTHER
P - PACIFIC ISLANDER
STAFF
STUDENT
U - UNKNOWN
W - WHITE
Sex:
F
FEMALE
M
MALE
N
DOB:
Driver License Number:
Licensing State:
Person Type
Name
Home Phone
Mobile Phone
Work Phone
Enter Incident Information
Please enter all the information that applies. If you do not know the address of the incident, use the nearest intersection such as Market St./ 10th St. Please ignore previous instructions. LB
Street Address:
City
 /
State
 /
Zip Code:
/
Country
 ,
 ,
,
Incident Time (start):
Incident Time (end):
Have Vehicle Info to Enter?:
Yes
No
Have Property Info to Enter?:
Yes
No
Have Digital Media to Enter?:
Yes
No
Origin of Threat:
Incident Description:
(Characters Left)
Enter Vehicle Information
Please enter the Vehicle information.
Type:
2 DOOR VEHICLE
4 DOOR VEHICLE
BICYCLE
BOAT - MOTOR
BOAT - NON-MOTOR
HATCHBACK
MOTORCYCLE
PICKUP TRUCK
RECREATIONAL VEHICLE
SEDAN
SPORT UTILITY VEHICLE
TRAILER
TRUCK
UNKNOWN
VAN
WAGON
Make:
ACURA
AUDI
BMW
BUICK
CADILLAC
CHEVROLET
CHRYSLER
DODGE
FIAT
FORD
GENERAL MOTORS CORP
GMC
HARLEY DAVIDSON
HONDA
HUMMER
HYUNDAI
INFINITI
ISUZU
JAGUAR
JEEP
KAWASAKI
KIA
KIA/JEEP
LAND ROVER
LEXUS
LINCOLN
MAZDA
MERCEDES BENZ
MINI
MITSUBISHI
NISSAN
OLDSMOBILE
PLYMOUTH
PONTIAC
PORSCHE
RAMBLER
RANGE ROVER
ROLLS ROYCE
SAAB
SATURN
SCION
SUBARU
SUZUKI
TOYOTA
TRIUMPH
VOLKSWAGEN
VOLVO
YAMAHA
Model:
Year (YYYY) :
Color:
BLACK
BLUE
BROWN
CHAMPAGNE
DARK BLUE
DARK GREEN
DARK RED
GOLD
GRAY
GREEN
MAROON
NAVY BLUE
ORANGE
PINK
PURPLE
RED
SILVER
TAN
WHITE
YELLOW
License Plate Type:
CT
MA
ME
NH
NY
OTHER
RI
VT
License Plate Number:
(do not enter spaces)
Licensing State:
VIN:
(do not enter spaces)
Insurance Company Name:
Insurance Policy #:
Insurance Policy Expiration Date:
Enter Property Information
Please enter the Property information.
OwnerShip:
CCSNH
CITY
MANCHESTER COMMUNITY COLLEGE
NHTI
OTHER
PERSONAL
RVCC OWNED
STAFF OR FACULTY
STATE
STUDENT
UNKNOWN
Type:
AUTOMOBILES
CELL PHONE
CLOTHES/FURS
CLOTHING
COMPUTER HARDWARE/SOFTWARE
CONSUMABLE GOODS
ELECTRONIC EQUIPMENT
GLOVES
IPOD/MP3
JEWELRY
JEWELRY/PRECIOUS METALS
LAPTOP
MEDIA/DVD/TAPE/PHOTO
MONEY/DEBITCARD/CREDITCARD
N/A
OFFICE-TYPE EQUIPMENT
PURSE/WALLET
PURSES/HANDBAGS/WALLETS
RADIOS/TVS/VCRS
STRUCTURES
STRUCTURES - BUSINESS
STRUCTURES-OTHER
TOOLS
VEHICLE PARTS/ACCESSORIES
WATCH
Subtype:
Brand:
Model:
Color:
BLACK
BLUE
BROWN
GRAY
GREEN
ORANGE
PINK
PURPLE
RED
TAN
WHITE
YELLOW
Serial Number:
How Many:
Approx. Market Value ($):
Property Description:
Select Digital Media
Please select any digital media (pictures, documents or any digital data files) up to 2047 MB that are relevant to this incident.
File Name
Title
Description
Review Report
Please review the report. If all the information is correct, click the Continue button to submit the report. If you need to modify some information, click the desired modify link. This will be your last chance to change information for this report.
General Information:
Incident Type(s):
Reporting Person/Involved Contact Information:
Incident Information:
Incident Location:
Incident Time (start):
Incident Time (end):
Origin of Threat:
Incident Description:
Vehicle Information:
Type:
Make:
Model:
Year (YYYY):
Color:
License Plate Type:
License Plate Number:
Licensing State:
VIN:
Insurance Company Name:
Insurance Policy #:
Insurance Policy Expiration Date:
Property Information:
OwnerShip:
Type:
Subtype:
Brand:
Model:
Color:
Serial Number:
How Many:
Market Value($):
Property Description:
Digital Media:
Your report has been submitted.
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