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Incident Report Form

If this incident is an immediate emergency please contact the KUMC Police at 913-588-5030

Please complete as much information as possible. All fields are required.

Your name:
Date of Incident: Time of Incident:
Phone: E-mail:
Other Personnel Involved:

Location of Incident:
What Happened:

 

 

 

 

     Last modified: Aug 14, 2012