Report • CampusOptics

Voluntary Self-Identification Information

Georgetown University is committed to the safety and well-being of all members of its community. This voluntary form allows individuals who may need assistance evacuating during an emergency to share emergency preparedness information with the University.

Community members whose disabilities or medical conditions may affect their ability to evacuate a building safely may choose to complete this form. The information provided helps emergency responders and University personnel better support individuals during emergencies. Individuals who complete this form may also request assistance developing a PERSONAL EMERGENCY EVACUATION PLAN (PEEP) with the Office of Environmental Health & Safety or the University Fire Marshal.

Confidentiality of Information

The University will maintain the confidentiality of the information provided through this form. Information will only be shared with personnel who have a legitimate need to know for emergency planning and response purposes.

In the event of an emergency, relevant information may be shared with:

Georgetown University Police Department (GUPD)
Office of Emergency Management (OEM)
The University Fire Marshal / Office of Environmental Health & Safety (EH&S)
Building Evacuation Coordinators (BECs) or other University personnel responsible for emergency response
District of Columbia Fire and EMS (DC FEMS) or other emergency responders, when necessary

Information will only be used to support emergency preparedness, evacuation planning, and life-safety response.

Additional Emergency Preparedness Option

In addition to sharing information with the University, community members may also choose to create a voluntary Smart911 safety profiles . Smart911 allows individuals to provide emergency responders with important information that may assist them during an emergency. More information about Smart911 is available through the Office of Unified Communications.

Reporter Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Name* Required

Additional Location Details

Exact Location

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Basic Information

Role

Role: If Other, Please Describe

Campus

Campus: If Other, Please Describe

If emergency responders needed to locate you during an emergency, where are you most likely to be on campus?

Location: If Other, Please Describe

Preferred Communication Method

Communication: If Other, Please Describe

Residence Hall/Room Number (if you live in University Housing)

Office Location: (if applicable)

Do you anticipate needing assistance evacuating a building during an emergency?

Do you use a wheelchair or mobility device that may affect your ability to use stairs?

What type of assistance might be helpful to you during an emergency evacuation?

Would you like assistance developing a Personal Emergency Evacuation Plan (PEEP)?

Additional Emergency Planning Information (Optional)

Please share any other information you would like the University to consider when assisting you during an emergency.

Add Supporting Documents

Add files to upload as supporting documentation along with your incident.