INCIDENT REPORT

This form is to report incidents of hazing and other inappropriate behavior. Submissions are processed 24/7/365. More information may be sent via email to samhq@sam.org. We ask that you provide your name and contact information, so a staff member can follow up with you concerning the allegation. Staff will keep your identity confidential. Your contact information will keep people safe by allowing us to conduct a more thorough investigation.

Sigma Alpha Mu has a Good Samaritan Policy to encourage calling 911 if someone needs medical attention without fear of personal or chapter disciplinary action. Thank you for assisting Sigma Alpha Mu in our efforts to eliminate hazing and other misconduct from our organization.

School

Name of University

Name of Individual Submitting Form

Email Address of Individual Submitting Form

Phone Number of Individual Submitting Form

Choose One or More of the following that applies to you:

Greek Community Member
Sigma Alpha Mu Member
Sigma Alpha Mu Candidate
University Faculty/Staff Member
Parent
Other

Location of Incident

Date of Incident

mm/dd/yyyy

Approximate Time of Incident

e.g. 2:00 A.M.

: HH

MM

Description of what you saw

Were there other witnesses?

Yes
No

If there were other witnesses, please include their names

Have you ever witnessed this behavior before?

Yes
No

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Find additional hazing support.

Confidential Incident Report Form

Sigma Alpha Mu's Risk Management Program and Policy

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