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SafeWatch Report

If this is an emergency or requires an immediate

response, please call 290-5911 for campus police.

This online form allows an individual to report information about incidents that adversely affect the campus.

General Information

Your Name:
Phone:
E-Mail:

Please indicate your affiliation to Lone Star College-CyFair:
Student Faculty Staff Visitor/Guest

Please indicate your gender:
Male Female

Report Information

Please indicate what the incident involved (check all that apply):

Discrimination: Age Color Disability Gender National Origin Political Affiliation Race Religion Sexual Orientation Veteran Status	Harassment/Threat: Age Color Disability Gender National Origin Political Affiliation Race Religion Sexual Orientation Veteran Status	Graffiti/Vandalism: Age Color Disability Gender National Origin Political Affiliation Race Religion Sexual Orientation Veteran Status
Assault: Verbal Physical Sexual Other Specify 'Other' below:	Stalking: Physical Cyber Retaliation Weapon Other Specify 'Other' below:	Other: Classroom Behavior Demonstration Hazing Other Specify 'Other' below:

Report Description

Date and time of the incident:

Suspect’s Name(s): (if known)

Description of Suspect(s): (if name is unknown)

If incident happened to someone else, please provide their name(s): (if known)

What happened? Please describe the incident as clearly as possible.

Where did the incident occur?

List the names of any witnesses who were present: (if known)

By completing and submitting this form, I hereby certify that the information I have provided in this report is true, correct, and complete to the best of my knowledge.

SafeWatch Report

If this is an emergency or requires an immediateresponse, please call 290-5911 for campus police.

General Information

Report Information

Report Description

If this is an emergency or requires an immediate

response, please call 290-5911 for campus police.