Significant Event – Emergency Management & Mission Continuity

Name*

First Last

Email

Location*

Street address or intersection preferred

Adjacent impacts/impacted areas*

Phone - immediate contact #

Summary of Events*

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Summary of Impact

Are there any conditions of concern?

Other Hazardous Conditions

Response

Which campus departments have been notified?*

Other Departments Engaged

Follow up actions and notes*

Comments

This field is for validation purposes and should be left unchanged.