Incident Report Form

Use this form to report accidents, injuries, medical situations, or student behavior incidents. (Incidents involving a crime or
traffic incident should be reported directly to the Campus Public Safety office.) If possible, the report should be completed
within 24 hours of the event. Submit completed forms to the President’s Office.

INFORMATION ABOUT PERSON INVOLVED IN THE INCIDENT

Full Name: Seto Kaiba
Home Address: N/A
X Student Employee Visitor Vendor
Phone Numbers Home : N/A Cell: N/A Work: N/A

INFORMATION ABOUT THE INCIDENT

Date of Incident : 11/29/XX Time: N/A Police Notified  Yes 
X No

Location of Incident : Duelist Kingdom (Island), Kame Game

Description of Incident (what happened, how it happened, factors leading to the event, etc.) Be as specific as possible
(attached
After additional
hours at sheetsGame
the local Kame if necessary)
shop, owned by Solomon Muto, Kaiba came to the Same Game store after learning of Solomon’s
rare and the 4th Blue Eyes white dragon card. After Kaiba’s workers messed the store up by ransacking it. Kaiba challenged Solomon to
a duel for the rare card, where Kaiba won and ripped up the 4th Blue eyes white dragon. His reasoning was that he
didn’t want the card handled against him in a duel. This shatters Solomon's heart and sends him to a hospital. He then forces Yugi to
duel him, with the intent to humiliate him and kill him off. Yet he fails and is forced to stay out of Yugi’s way, only interfering and
appearing later to duel Yugi Muto.

Were there any witnesses to the incident? 

X Yes  No
If yes, attach
Name: separate sheet with names, addresses, and phone numbers.
Yugi Muto
Was the individual injured? If so, describe the injury (laceration, sprain, etc.), the part of body injured, and any other
Kaiba shows extreme arrogance and selfishness, along with being disrespectful. Kaiba is organized and to the point with his plans and
information known about the resulting injury(ies).
schemes. Proving him to be a type A personality, which explains his chronic competitiveness, impatience, and aggression. Which are
common traits of a type A personality (Sharma). Kaiba uses his pride as his motivation, his reason to do everything is to defeat Yugi in
a dual. His personality shows signs that he would offend again. Throughout the series, Kaiba acts as an anti-hero to only spite and
take Yugi down.

Was medical
Formal treatment
Charges:  Yes murder,
provided?Attempted
Abuse, Kidnapping,  No Blackmail
 Refused
If yes, where was treatment provided:  on site  Urgent Care  Emergency Room  Other

REPORTER INFORMATION
Individual Submitting Report (print name): Domino city policeman #443

Signature

Date Report Completed: 11/29/XX

FOR OFFICE USE ONLY

Report Received by __________________________________________________ Date _________________________________