College Prep Program Incident Report

In the event of an incident that involves a Code of Conduct Violation, suspected or witnessed Child Abuse or Neglect, or an accident, injury, or medical concern, College Prep Program staff must report the incident according to all requirements (including mandated reporter status, reporting the event to a member of the Leadership Team, notifying WUPD, etc. according to the situation). The staff member reporting the incident must also complete a College Prep Program Incident Report using the form below.

Note: If the incident relates to child abuse or neglect, you must also notify the Missouri Child Abuse and Neglect Hotline at (800) 323-3738 to report the incident to them as well.

CPP Incident Report

Information about Individual Filing Report

Person(s) Involved in the Incident

Did the incident involve one or more scholars?
Did the incident involve one or more College Prep staff members (Leadership Team, Graduate Fellows, Program Assistants, Tutors, etc.)?
Did the incident involve one or more other individuals who are not scholars or part of the College Prep team (such as instructors, other WashU staff/students, stranger, parents, etc.)?

Information Regarding Incident

Time of Incident (Approximation is ok)
Type of Incident
Did the incident involve a minor?
Did the incident occur while staff supervision was present?
Were there any witnesses to the incident (other than the individuals involved)?
Was anyone injured?
Was the WashU Emergency Team contacted (by calling 314.935.5555)?
Was medical treatment provided?
If yes, where was treatment provided?
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