UNIVERSITY OF WISCONSIN River Falls

University Police

Campus Security Authority Report Form

This report is for Campus Security Authority Officers to report incidents on or around campus in compliance with the Clery Act.

  mm/dd/yyyy
(If known.)
Involved Parties
Describe organization or person. Include name; gender; the person's role (alleged offender, victim, witness, bystander, security); email address; phone number; physical address.
Describe organization or person. Include name; gender; the person's role (alleged offender, victim, witness, bystander, security); email address; phone number; physical address.
Describe organization or person. Include name; gender; the person's role (alleged offender, victim, witness, bystander, security); email address; phone number; physical address.
Describe organization or person. Include name; gender; the person's role (alleged offender, victim, witness, bystander, security); email address; phone number; physical address.
Questions

This questions will help us better understand what occurred and the nature of any follow-up needed as well as how to report the incident for Clery purposes. What type of incident(s) was this? Check all that apply.

What is the relationship between the victim and the offender?

As a Campus Security Authority, what action have you taken?

If there was a bias motivation involved in this incident, what type to you believe it to be?

What if any law enforcement agency has been notified of this incident?