Jefferson, Philadelphia University + Thomas Jefferson University Logo

Incident/Concern Report Form

Thomas Jefferson University is committed to fostering a safe and welcoming campus community. In turn, it is the responsibility of each person within the University community to join in creating an environment in which others have a positive experience and promote inclusion and respect.

If you need to report an emergency or are reporting an incident that poses an imminent risk of harm, contact the Department of Public Safety at:
East Falls Campus: 215-951-2999
Center City Campus: 215-955-8888 (Campus Phone 811)
Or dial 9-1-1.
Please Note: that completing this report does not substitute contacting the police.

This incident report form is available to anyone who would like to notify the University about the following involving a TJU student:

Student Concern: for a student whom you feel may be struggling physically or psychologically.

Student/Student Organization Misconduct: that allegedly occurred on or off campus.

Upon submission, a staff member will review the report and provide necessary support and/or reach out to gather more information.

When submitting this report, please include as many details as possible including name, title, and contact information.

Please Note: this form may not be reviewed outside of normal business hours.

Additional Reporting Options:
To report a violation of the Academic Integrity Policy, use the Academic Integrity Reporting form.

To report a Behavioral Concern, use the Jefferson Behavioral Intervention Report form.

To report Bias or Discrimination, use the Harassment (Discrimination) Reporting form.

To report Sex and Gender-Based Misconduct, use the Sex and Gender-Based Misconduct form.

Background Information of the Person Submitting this Report

Enable additional features by logging in.

Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Affiliation at the university(Required):

This field is required.

Date of incident(Required):

This field is required.

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please include any known contact information for the individuals involved in the incident (do not include yourself).

Student Name or Organization

Affiliation at the University

Campus key

Phone number

Email address

Campus or Permanent Address

Incident Information

Please select all categories that apply to the incident you are reporting.(Required)

Student Concern Student Misconduct Student Organization Misconduct

You must make at least one selection.

Please provide a detailed summary of the incident of concern.(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report