Campus Safety Security Reporting Form

General Information

This is the basic information about the type of report this is.

Employee Name*

Nature of this report*

What Crime(s)?

Describe each crime suspected, separated by commas.

Urgency of this report

Date incident was reported to you*

This is the date you learned of the incident, or the date you noticed the issue.

Date and time of incident*

Describe the time and date of the incident, or the time span. If something was stolen, enter the date/time the loss was last known to be there, and then the date/time the loss was discovered missing.

Location of incident*

Choose the location closest to where the incident occurred

Specific location of incident*

Include room numbers if applicable. Be as specific as you can.

Theft/Vandalism/Missing or Lost Items*

Does this report involve theft, vandalism, or missing/lost items?

Yes

Property

Property Loss

Describe the lost, missing, or damaged property. Include all available information, including make, model, color, serial number, and ESTIMATED VALUE of each item of loss. You may need to re-contact your reporting party for this information, so it’s best to get it before you need it.

Hidden

Facilities / Maintenance*

Did this incident require, or will it require, assistance from Facilities, Maintenance, and Operations (FM&O) personnel to secure the area or repair any damage?

Yes

Work Performed or Required

What has been done and/or what still needs to be done by FM&O personnel? **NOTE:** Include the TCSR number (work order number).

Vehicles*

Did this incident involve any vehicles?

Yes

Involved Vehicle(s)

Vehicle Details

Describe each vehicle, including all of the following, if known: License #/State, Driver, Color, Make (Ford, Chevy), Model (Prius, Outback), Body Style (passenger car, SUV, pickup, etc.), and other identifying marks such as dents, bumper stickers, etc.

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list an SSN or Drivers License number in the block labeled “TC A# (or other ID Number)” if available. Use the “+” button at the end of this section to add more involved parties

Please list any involved parties.

Name or Organization (Last, First for names)	Select Gender	Select Role	TC A# (or other ID Number)	DOB	Phone	Email	Address	Other identifying descriptors	Actions

There are no Involved Parties..

Narratives

Notification

Describe how you became aware of the situation (phone call, radio, observation, etc.) Where were you and what were you doing when you became aware of the situation?

What happened?

What was reported to you (or what did you observe)? Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, and how).

What were your actions, if any?

What did you do after you were made aware of the incident? For example, did you notify anyone? Did you discuss the incident with others? If so, whom? Did you provide information to anyone? If you took no significant actions other than reporting, enter “none.”

Questions

Has the Taft Police Department been notified?*

Yes

I don’t know

Other

Case Number or Incident Number

If known

What is the primary concern for this report?

Academic

Conduct

Traffic / Parking

Crime

Housing

Medical

Mental Health

Other

Supporting Documentation

File

Photos, .pdf, MS Word, and certain other supporting document types may be attached below. 80 MB maximum total size. Attachments require time to upload, so please be patient after submitting this form.

Drop files here or

Accepted file types: jpg, gif, png, pdf, docx, doc, jpeg, xls, xlsx, txt, mp4, mov, mp3, mpeg, mpg, Max. file size: 80 MB, Max. files: 6.

Untitled

Name

This field is for validation purposes and should be left unchanged.