Campus Security Authority (C.S.A.) Incident Report Form

Campus

Shawnee State University

Off campus; non-university affiliated location

Incident Category

Select all that apply

Homicide - Murder

Non-negligent manslaughter; and negligent manslaughter (including vehicular manslaughter)

Aggravated Assault

Unlawful attack upon another with intent to inflict sever injury or great bodily harm

Sex Offense

Rape

Incest

Statutory Rape

Fondling

Burglary

Unlawful entry into a structure to commit a felony or theft

Robbery

Taking or attempting to take something by force; violence; threat; or by putting 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 Violation

Underage possession or consumption; distribution to minors

If liquor violation, did incident involve an arrest (any individual) or a student disciplinary referral?

Arrest

Disciplinary Referral

Drug Violation

Use, possession, or distribution of controlled substances or possession of drug paraphernalia

If drug violation, did incident involve an arrest (any individual) or a student disciplinary referral?

Arrest

Disciplinary Referral

Weapon Law Violation

Possession or use of an illegal weapon

If weapon law violation, did incident involve an arrest (any individual) or a student disciplinary referral?

Arrest

Disciplinary Referral

Dating Violence

Domestic Violence

Felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim

Stalking

Engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for his/her safety or the safety of others

Other Crime Category

Reported by

Was the crime reported to you by the victim, a third party, or both?

Third Party

Victim

Both

If a third party reported the crime to you, please enter the relationship of the third party to the victim

Reporting Party Name (Do not enter if confidentiality is requested)

Reporting Party Phone Number (Do not enter if confidentiality is requested)

Incident Location

What best describes the location of the crime? If the crime occurred in multiple places, check all that apply

On campus, residence hall

On campus, not in a residence hall

Public property immediately adjacent to campus (sidewalks, streets, etc.)

Off Campus in University owned leased or controlled space

Unknown location or other

Incident Address

Campus Security Authority (C.S.A.) Incident Report Form

Campus

Incident Contact Information

Incident Details

Incident Category

Agency Notified

Reported by

Incident Location

Motivated by Bias

Breadcrumb

Campus Security Authority (C.S.A.) Incident Report Form

Campus

Incident Contact Information

Incident Details

Incident Category

Agency Notified

Reported by

Incident Location

Motivated by Bias