UCBerkeley Death Report - Confidential
This report should be completed and sent to the appropriate office within 24 hours. The report should be forwarded within this timeframe, even if you are not able to fill in every field of the form. PLEASE INFORM THE DEPARTMENT COORDINATOR OF RECEIPT OF THIS REPORT.
  • INFORMATION ABOUT THE DECEASED

  • / /
  • / /
  • (e.g. home, university property (including housing), hospital...)
  • (month/year)
  • (month/year)
  • INFORMATION ABOUT INDIVIDUAL WHO REPORTED THE DEATH TO THE UNIVERSITY

  • COORDINATOR OF NOTIFICATION PROCESS