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LSA Group Travel Incident Report

If you encounter an incident regarding your health and/or safety while abroad, please fill out this form. Once completed, the LSA / CGIS Health & Safety Advisor (Rachel Reuter) will follow-up with you within 2 business days.

If this is an emergency situation and you require immediate assistance, please call the University of Michigan police at (734) 763-1131.

Name & Email Address

Where are you currently located?

When did the incident occur?

Date/Time Approximately

Who was involved?

Please list name(s) and email(s) of individuals involved in incident.

Description of Incident:

Please be as specific as possible: (what happened, how, injuries, when and from whom you heard about incident, etc.)

Describe Actions Taken After Event:

i.e. Have you contacted GeoBlue? Has a police report been filed? Have you contacted your UM Administrator?