Arkansas Court Security Incident Report
Administrative Office of the Courts
625 Marshall St. Little Rock, AR. 72201
Fax (501) 682-9410
Report must be submitted not later than the 3rd business day after the date the incident occurred.
This form is for administrative purposes only. If law enforcement is needed, contact the local police department or sheriff's office.
1. Information of Person Completing Report:
First:
Last: Cell Phone:
Title:
Email:
2. Type of Court:
District
Circuit
Name of Courthouse:
Not related to a particular court type
3. County:
4. Incident Date:
Time:
AM
PM
5. Type of Incident:
Physical assault Disorderly conduct
Bomb threat
Threat
Type of threat:
Verbal
Written
Threat against:
Judge, officer, staff
Other:
Prisoner escape attempt
Attempt to bring a weapon into the courtroom
or
court facility
Other:
6. Location of Incident:
Courtroom of: Judge
Other judicial officer
Chambers of: Judge
Other judicial officer
Staff offices of: Judge
Other judicial officer
Clerk's office
Holding area
Parking area
Public area of court facility
Other:
7. Was a Weapon Involved?
No Yes, type of weapon:
Gun Knife Blunt object
Other:
8. Was Anyone Injured?
No Yes, type:
Medical attention?
Yes No
9. Who Was the Perpetrator?
Name:
Criminal defendant
Plaintiff/non-criminal defendant
Family member/friend of a party in the case
Member of public
Other:
Was the individual charged as a result of this incident?
No Yes Pending
10. Was the Incident Reported to Law Enforcement?
No
Yes, name of agency:
11. Was this Incident Related to a Particular Case?
No
Yes, Type of case:
Case Number:
12. Description of Incident: (Use separate sheet if needed)
