Workplace Violence Incident Report - The College at Brockport

It is a crime, punishable as a Class A misdemeanor, under the laws of New York State, for a person, in a written instrument, to knowingly make a false statement which such person does not believe to be true.

1Individual Information > 2Incident Information > 3Assailant Information > 4Incident Results > 5Review Your Entry
1. Name of individual - victim/potential victim 1. Name of individual - victim/potential victim First Last
2. Job Title
3. Age
4. Gender
5. Work Phone Number 5. Work Phone Number - ### - ### ####
6. Alternate Phone Number 6. Alternate Phone Number - ### - ### ####
Email
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