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Individual writing report

Today's Date (mm/dd/yyyy)

Name of program

Type of Program

OHIO Study Abroad Program
OHIO Study Away Program
OHIO Exchange Program
OHIO affiliated travel (e.g. research, non-credit groups, independent travel)
NON-OU Program
Other

Incident Date(s)

Time of Incident (specific time or a range may be entered)

Location of Incident (City, Country OR City, State)

Provide a description of incident (Who was involved? What happened? When did it occur? Where did it occur?):

Please stick to observations and facts and refrain from adding opinion. Responses to questions in emergency response guideline document are appropriate to include. Please use PID to identify student when sensitive information is included (e.g. medical diagnosis, information on victimization).

International SOS Case # if applicable

Actions taken by program-affiliated personnel in response to incident (e.g. call to local authorities, ISOS, OGO emergency line, or other OHIO officials, medical provider visit):