Campus Security Authority Incident Report Form

This form is to be completed whenever any designated Campus Security Authority becomes aware of a crime reported by a student, faculty member, staff member, guest, or third party. Even if the person making the report states that the crime has been reported to a police agency or the Department of Public Safety, it is important that this form be promptly completed.

Name of Campus Security Authority Completing Form

Description of Incident

Homicide- murder, non-negligent manslaughter, and negligent manslaughter (including vehicular manslaughter).
Aggravated assault - unlawful attack upon another with intent to inflict severe injury or great bodily harm.
Burglary - unlawful entry into a structure to commit a felony or theft.
Robbery - taking/attempting to take something by force, violence, threat, or by putting a victim in fear.
Motor vehicle theft - theft of automobiles, trucks, etc., including “joyriding” (taking by person without lawful access).
Arson - willful or malicious burning/attempt to burn structure, vehicle, or personal property of another.
Liquor, drug, and weapon law violations – underage possession/consumption; distribution to minors; use, possession, or distribution of controlled substances; possession or use of an illegal weapon.
Larceny -The unlawful taking, carrying, leading, or riding away of property from the possession or constructive possession of another.
Vandalism - To willfully or maliciously destroy, injure, disfigure, or deface any public or private property,
real or personal, without the consent of the owner or person having custody or control by cutting, tearing, breaking, marking, painting, drawing, covering with filth, or any other such means as may be specified by local law.
Intimidation - To unlawfully place another person in reasonable fear of bodily harm through the use of threatening words and/or other conduct, but without displaying a weapon or subjecting the victim to actual physical attack.
Simple Assault- An unlawful physical attack by one person upon another where neither the offender displays a weapon, nor the victim suffers obvious severe or aggravated bodily injury involving apparent broken bones, loss of teeth, possible internal injury, severe laceration or loss of consciousness.
Hate Crimes - the listed crimes can be classified as hate crimes when the victim is intentionally selected due to race, gender, sexual orientation, ethnicity, disability, national origin, religion,
or gender identity.

Sexual Assault - Any sexual act directed against another person, without consent of the victim, including instances where the victim is incapable of giving consent. Sexual Assault includes rape, which is the penetration, no matter how slight, of the vagina or anus, with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim. This offense
includes the rape of both males and females.
Fondling - the touching of the private body parts of another person for the purpose of sexual gratification, without the consent of the victim, including instances where the victim is incapable of giving consent because of his/her age or because of his/her temporary or permanent mental incapacity.
Incest - sexual intercourse between persons who are related to each other within the degrees wherein
marriage is prohibited by law.
Statutory Rape - sexual intercourse with a person who is under the statutory age of consent.
Domestic Violence - felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabiting with or has cohabited with the victim, as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred, or by any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred.
Dating Violence - committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on the reporting party’s statement and with consideration of the length of the relationship, the type of relationship; and the frequency of interaction between the persons involved in the relationship.
Stalking - engaging in a course of conduct directed at a specific person that would cause a reasonable
person to; fear for his or her safety or the safety of others; or suffer substantial emotional distress.

Victim Information

If No, please provide the victim’s name and contact information.