Exam Misconduct Incident Report Form
Report an exam misconduct incident with key details, people involved, supporting evidence, and a clear narrative of what happened.
Incident Details
Incident Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Exam or Course Name/Code
*
Location or Exam Room
*
Type of Misconduct
*
Please Select
Cheating
Unauthorized Materials
Impersonation
Disruptive Behavior
Plagiarism During Exam
Other
People and Witnesses
Reporter Full Name
*
First Name
Last Name
Reporter Role / Position
*
Accused Student Full Name or Internal Student ID
*
Witness Names and Contact Notes
Incident Narrative and Evidence
Detailed Incident Description
*
Evidence or Attachments
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of
Immediate Action Taken / Escalation Notes
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