Swosu Crime Incident Report Form printable pdf download

Crime Incident Report Form

This form should be completed by those individuals identified as “campus security authorities”

who are required to report information they receive about specified crimes (described below)

pursuant to the federal Clery Act. The information collected from these forms will be used to

prepare a compilation of statistical crime information that will be included in the campus’ Annual

Security Report.

It is the policy of the SWOSU to ensure that victims and witnesses to crime are aware of their

right to report criminal acts to the police, and to report University policy violations to the

appropriate office (e.g., student conduct violations to the Office of Dean of Students). However,

if a reporting person requests anonymity, this request must be honored to the extent permitted by

law. Accordingly, no information should be included on this form that would personally identify

the victim without his/her consent.

SWOSU Campus Police will use this form to determine the category of crime and location under which the

crime should be reported according to the requirements of the Clery Act. Please forward this

completed form to:

SWOSU Campus Police Department via campus mail or fax (580) 774-7116

Person Receiving Report: ____________________________

Phone Number: ________________

Report Made by:

______Victim

______Third Party Please identify relationship to victim: _______________________________________

Date and Time the Incident occurred: ______________________________________________________

Description of the incident or crime: _______________________________________________________

____________________________________________________________________________________

Location of Incident

Identify building name, address, etc.; be as specific as possible): _________________________________

____________________________________________________________________________________

Swosu Crime Incident Report Form