University of South Florida

Environmental Health & Safety

A Department of Facilities Management

Tobacco Free

Incident Report Online Incident Report Form

To report an incident related to USF's Tobacco- and Smoke-Free Policy, please fill out this form or send the information to tobaccofree@usf.edu. Compliance is everyone’s business.

Date observed:
Location observed (be as specific as possible):
Time observed:
Number of smokers/tobacco-users observed at the location:
Description of smoker(s)/tobacco user(s). Give as much information as possible, e.g., male or female, clothing, glasses, hair color and style, facial hair, student, staff, visitor, vendor:
If you know their names, please list and identify if they are faculty, staff, or students:
Did you approach the smoker(s)/tobacco user(s) and remind of the tobacco-free policy?:
If yes, did the smoker(s)/tobacco user(s) comply with the tobacco-free policy?:
Please enter your email address so the committee can follow-up with you. All submissions will be kept confidential:
Additional comments: