Crime Incident Report Template PDF
Crime Incident Report Template PDF
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
______Victim
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Location of Incident
Identify building name, address, etc.; be as specific as possible): _________________________________
____________________________________________________________________________________
The location where this incident occurred was:
Sex Offenses
Examples of sex offenses are rape, sodomy, sexual assault with an object, fondling, incest, and
statutory rape.
If yes, were the victim and the assailant acquainted? ______ Yes ______ No
If yes, were either the victim or the assailant under the influence of alcohol or drugs?
Hate Crimes
Hate crime information is required to be reported for each of the following crimes (criminal
homicide, sex offense, robbery, aggravated assault, burglary, motor vehicle theft, and arson) and
for any other crime involving bodily injury.