7.1

Campus Security Authority Report Form

Review the following video to learn how to access, fill out, and submit the Campus Security Authority Incident Report Form.

Press play to watch the video below. For the best viewing, please watch the video in full screen mode.

To view the captions click the Closed captioning icon icon on the bottom right side of the video player.

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The first step to reporting a crime using the Campus Security Authority Incident Report Form is to access the form by going to www-dot-police-dot-psu-dot-edu-forward-slash-clery.

Once on the page you will see a Quick Links menu. Click on the first link “Campus Security Authority Incident Report Form.” This will open the form.

The best approach for the form is to fill in as much information as you know about the incident. We will go through some of the most important pieces.

  • Campus is a critical piece; notice it is in bold red, which means it is a required field and cannot be left blank.
  • When the incident was reported to you.
  • For dates try to give the date the incident occurred, even if it is a range.
  • Choose an Incident Category; you don’t need to be an expert. Just take your best guess based on your training.
  • Fill out Reporting party information if you have it, but DO NOT enter information if the party has requested confidentiality.
  • Try to include information about the location of the incident, even if it was multiple locations.
  • Complete any other sections you can.

When you are done filling out the form, you may submit via the button at the bottom of the page or you could print the document and send it via campus or U.S. mail to the University Police and Public Safety Office.

If you provide your contact information on the incident report form, the Compliance Manager, or a proxy, will contact you to provide information on programs for assisting victims of sexual and other assaults as well as procedures for seeking medical help. This information should be passed on to the reporting person if they are interested in receiving it.

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How to fill out a Campus Security Incident Report Form

Review: There are three steps to using the CSA Incident Report Form to report a crime:

1) Access the form

Campus Security Authority Incident Report Form

If you click the link, you will be taken to a new window with the Campus Security Authority Incident Report form. After you review the form, please return to this training.

2) Fill out the form

Be sure to include the following:

  • The campus where the incident occurred
  • Timing of the incident
  • Type of incident
  • General location of the crime

Helpful Tips:

  • It is helpful to provide information about weapon use in the crime and identities of any known suspects or witnesses.
  • The name of the victim or person reporting to you should not be provided unless they wish to be identified.
  • Get the information the person wants to tell you; the University Police will decide what type of crime has occurred.

3) Submit the form

  • You can submit the form online after completion. When the form is submitted, it will go directly to Compliance Manager Gabe Gates, or the head of security at your campus.
  • You can email the form to: cleryform@psu.edu. This will go directly to the Compliance Manager for immediate review. When you submit the form, if you supply your contact information on the incident report form, the Compliance Manager, or a proxy, will contact you to provide information on programs for assisting victims of sexual and other assaults, as well as procedures for seeking medical help. This information should be passed on to the reporting person if they are interested in receiving it.
  • You may also report the crime by mailing the incident report form via campus or U.S. mail to:
    University Police and Public Safety
    Attention Compliance Manager
    30 Eisenhower Parking Deck
    University Park, PA 16802
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