Cerro Coso Community College

Incident/Accident Reporting Form

This form is to be used to report incidents, accidents or illnesses requiring medical aid observed on campus at, or related to Cerro Coso Community College. If this report is regarding an emergency or other life threatening situation, call 911. If this is a report of non-emergency criminal activity, please call local law enforcement as well as filing a report on this page.

Examples of reportable incidents include (but not limited to) threats, violations of student conduct policies, near miss accidents, hazardous conditions, criminal activity, etc.

Examples of reportable accidents include slip or trip and falls, traffic collisions, other injury or property damage producing situations, etc.

Examples of reportable illness include illness that require emergency medical attention or first aid.

Please remember that you may remain anonymous, however, we may have additional questions for you in order to adequately investigate your concern. Please fill out this form as completely as possible.

Reporting Party Contact Information
Parent/Guardian Information
Incident/Accident Information
Room number, gym parking lot, main parking lot, hallway in the east wing, apartment address, etc.
Description of Incident/Accident
Briefly describe additional evidence, photos or documents, if any. Then email or deliver them to: Safety/Security, Cerro Coso Community College, 3000 College Heights Blvd., Ridgecrest, CA 93555, cc_safety@cerrocoso.edu.
Witness 1 Contact Information
Witness 2 Contact Information
Witness 3 Contact Information
Other Responsible Party Contact Information (If Known or Applicable)
If another person was responsible for incident/accident, please provide information for this other responsible party.
Please include height, weight, etc.
Please list any additional responsible parties here.
Kern Community College District