Incident Report Form

Note: Please use this form to report any incidents that occur during the program. Examples of incidents to include are given below. If you are having technical difficulties completing this form, please contact Kelly McLaughlin with the details of the incident:

Kelly McLaughlin, Study Abroad Director

Office: (203) 432-0241
Cell: (203) 500-6051
24 Hour Yale Security: (203) 785-5555
kelly.mclaughlin@yale.edu

If you have not yet contacted International SOS and need in-country assistance, call 1.215.942.8478.

Examples of incidents that should be reported:

• Accident with or without injuries (e.g. bicycle or car)
• Allegations of sexual assault (see “Handling an Incident of Sexual Assault Abroad”)
• Arrest or impending arrest
• Behavioral issues and/or disruptions to individual/group dynamics
• Confirmed missing student
• Damage to program facilities
• Harassment (e.g. aggressive pressure or intimidation)
• Hospitalization with life-threatening injuries
• Immediate risk to student or group (natural disaster, public health risk)
• Kidnapping
• Life threatening medical emergency
• Lost or stolen property including passports
• Minor injury when student is admitted to the hospital (e.g. broken wrist)
• Multiple injuries and/or multiple stays or long-term hospitalization
• Natural disasters that disrupt the program, or threaten student safety
• Physical assault
• Political/civil unrest (e.g. significant involvement of local authorities)
• Political environment that has become unsafe for students or poses immediate risk
• Possible need for medical evacuation
• Psychological issues (e.g. sudden onset of psychological condition)
• Public health risks/infectious disease outbreaks
• Recurring alcohol abuse (e.g. impacts participation in social or academic activities)
• Removing student from the program (willing or unwillingly)
• Serious threats of terrorism or war
• Severe psychological problems that render a student a threat to themselves or others
• Student death
• Theft that involves assault or break-in (e.g. mugging, homestay break-in)
• Violent protests or riots, bomb threats, significant political unrest that disrupts the program, or threatens student safety

Immediately contact Kelly McLaughlin if the incident involves any of the following:

• Arrest
• Assault    
• General Disorder, Natural Disaster, or Terrorist Event
• Hospitalization for accident/injury or severe illness
• Missing Person
• Psychological Crisis
• Traffic or pedestrian accident involving student(s)
• Serious Injury or Death

How to Complete this Form

Please complete all relevant information below and submit within 24 hours. You might not need to, or be able to, complete all sections. Please provide as much detail as possible, and that is reasonably available to you at this time. You can follow-up to add or revise information as needed.