Global Projects Program Incident Report

This form is for WPI faculty advisors to report incidents that occur within WPI’s Global Projects Program, (GPP). For any emergency where a WPI student's well-being is in jeopardy, please contact [either the local emergency services or International SOS on +1 215-942-8478] and subsequently the Global Projects Program Duty Officer on +1 508-769-0117. Regardless of time of day you have people available to assist you 24/7.

This form will be sent directly to the GPP Duty Officer. You may be contacted for additional information or clarification if needed. If you are concerned about a student, but do not wish to submit your concern(s) through this form, please contact the GPP Duty Officer directly at +1 508 769 0017.

Note: If you are concerned about a student or faculty, who has experienced a Title IX violation, is the victim of a Title IX violation of the Sexual Misconduct Policy, or has committed a Sexual Misconduct Policy Title IX violation, please complete the Title IX Violation form. This form will be sent directly to the Title IX Coordinator.

Name of the person completing this report *

Email of person completing this report *

Local phone number of the person completing this report *

Today's date * +

Name of Program (or Program site - city, country)

E.g. IQP Namibia A19, MQP Cape Town B20, HUA Japan E19, Athletic, Student Organization, etc. *

Incident Type - Please tick all that apply *

Date and Time of Incident

Date of Incident * +

Local time of Incident *

Location of Incident - City & Country *

Where exactly did this incident occur?

As much detail about address or space as possible *

Were you present? *

Yes

No

How many participants were involved? *

Please provide a detailed description of the incident/concern using specific, concise, objective language (WHO, WHAT, WHERE, WHEN AND HOW). *

What actions did you take? *

Upload attachments

Maximum file size of 10MB. For large files, please contact gppdutyofficer@wpi.edu

Country of Origin: *

*

By providing the information requested in this form, you are consenting to WPI’s use of the provided information for the purpose for which the form is being used.

Illness	Student Participation	Structure Fire
Sexual Harassment/ Assault	Student Conduct	Missing/ Separated Person
Mental Health/ Psychological	Terrorism	Disease Outbreak
Theft	Housing Issue	Burglary
Injury	Robbery	Personal/ Interpersonal
Motor Vehicle Accident	Physical Assault	Natural Disaster
Arrest	Faculty	Free time
Other Other