Fillable Campus Security Authority Reporting Form If multiple incidents (St. Martin's College)

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Campus Security Authority Reporting Form If multiple incidents (St. Martin's College)

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Campus Security Authority Reporting Form
Date of report: ___________________________________________________________
Name of campus security authority: __________________________________________
Date that incident occurred (mm/dd/yyyy): ____________________________________
If multiple incidents were reported or if the date the incident occurred is unknown, please
note below:
Reporting Person Contact Information
Reported By: The Victim
☐
A Third Party
☐
First Name:
Last Name:
Phone Number:
E-mail Address:
If a third party reported the crime to you, please enter the relationship of the third party to the
victim: ________________________________________
Agency Notified
If, to your knowledge, a law enforcement agency was notified, please enter the name of that
agency.
Agency:
________________________________________________________________________
Does the victim want the incident reported to law enforcement? Yes ☐ No ☐
Incident Information
Location of incident (building name, street address, office number):
________________________________________________________________________
Time of incident (if known): ________________________________________________
Incident description (Please provide specific, detailed information; can attach additional
document if necessary.)
SEE NEXT PAGE
SAINT MARTIN’S UNIVERSITY
Campus Security Authority Reporting Form
Once completed, please send this form to:
[Attn: Director – Office of Public Safety, OM Rm 215]
Incident category:
(Please see attached for definitions of offenses.)
Homicide
☐
Burglary
☐
I am not sure how to
classify this
incident.
☐
Sex Offense
☐
Robbery
☐
Aggravated Assault
☐
Arson
☐
Motor Vehicle Theft
☐
Dating Violence
☐
Domestic Violence
☐
Stalking
☐
Hate Crime
Please see below for
additional information.
☐
Arrest for Liquor
Law Violation
☐
Referral for Liquor Law
Violation
☐
Arrest for Drug Law
Violation
☐
Referral for Drug Law
Violation
☐
Arrest for Weapons
Law Violation
☐
Referral for Weapons Law
Violation
☐
Other Crime
Category
If the crime was not listed above, please enter the additional crime
category: ______________________________________________
Is there any evidence that this crime was motivated by bias? Yes ☐ No ☐
If yes, please choose any/all categories of prejudice that apply.
☐
Ethnicity
☐
Disability
☐
Gender Identity
☐
☐
Religion
☐
National Origin
☐
Sexual Orientation
☐
If you answered “yes” to the Motivated by Bias question, please provide a brief summary of the
evidence supporting a bias motivation:
SAINT MARTIN’S UNIVERSITY
Campus Security Authority Reporting Form
Once completed, please send this form to:
[Attn: Director – Office of Public Safety, OM Rm 215]
SEE NEXT PAGE
Location
What best describes the location of the crime? (If the crime occurred in multiple places, check all
that apply. Please see the attached for further explanation as to the geography.)
☐ On campus, residence hall
☐ On campus, not in a residence hall
☐ Public property immediately adjacent to campus
☐ Non-campus in a University owned leased or controlled space (fraternity, sorority,
off-campus classroom)
☐ Unknown location, other
☐ I do not know which category this location would fall under.
Please review the information within the form. When complete, submit the form to:
Office of Public Safety
Attn: Director
mailto:PublicSafety@stmartin.edu
360-438-4555, Old Main Room 251
Crime Definitions
Homicide
• Murder/non-negligent manslaughter: the willful (non-negligent) killing of
one human being by another
• Negligent Manslaughter: the killing of another person through gross
negligence
Sex Offenses
• Sex offenses: Any sexual act directed against another person without the
consent of the victim, including instances where the victim is incapable of
giving consent
• Rape: The penetration, no matter how slight, of the vagina or anus with any
body part or object, or oral penetration by a sex organ of another person,
without the consent of the victim
• Fondling: The touching of the private body parts of another person for the
purpose of sexual gratification, without the consent of the victim, including
instances where the victim is incapable of giving consent because of his/her
age or because of his/her temporary or permanent mental incapacity
• Incest: Sexual intercourse between persons who are related to each other
within the degrees wherein marriage is prohibited by law
• Statutory Rape: Sexual intercourse with a person who is under the statutory
age of consent
Robbery
Taking or attempting to take anything of value from the care, custody, or control of a
person or persons by force or threat of force or violence and/or by putting the victim
in fear
SAINT MARTIN’S UNIVERSITY
Campus Security Authority Reporting Form
Once completed, please send this form to:
[Attn: Director – Office of Public Safety, OM Rm 215]
Aggravated
Assault
Unlawful attack by one person upon another for the purpose of inflicting severe or
aggravated bodily injury
Burglary
Unlawful entry of a structure to commit a felony or a theft
Motor Vehicle
Theft
The theft or attempted theft of a motor vehicle
Arson
Willful or malicious burning or attempt to burn with or without intent to defraud a
dwelling house, public building, motor vehicle or aircraft, personal property of
another, etc.
Dating Violence
Violence committed by a person who is or has been in a social relationship of a
romantic or intimate nature with the victim; and where the existence of such a
relationship shall be determined based on a consideration of the following factors:
• the length of the relationship
• the type of the relationship
• the frequency of interaction between the persons involved in the
relationship
Domestic Violence
Felony or misdemeanor crimes of violence committed by a current or former spouse
or intimate partner of the victim, by a person with whom the victim shares a child in
common, by a person who is cohabitating with or has cohabitated with the victim as
a spouse or intimate partner, by a person similarly situated to a spouse of the victim
under the domestic or family violence laws of the jurisdiction…or by any other
person against an adult or youth victim who is protected from that person’s acts
under the domestic or family violence laws of the jurisdiction
Stalking
Engaging in a course of conduct directed at a specific person that would cause a
reasonable person to fear for his or her safety or the safety of others, or suffer
substantial emotional distress
Liquor Law
Violation
The violation of state or local laws or ordinances prohibiting the manufacture, sale,
purchase, transportation, possession, or use of alcoholic beverages
Drug Law
Violation
The violation of laws prohibiting the production, distribution and/or use of certain
controlled substances and the equipment or devices utilized in their preparation
and/or use
Illegal Weapons
Possession
The violation of laws or ordinances prohibiting the manufacture, sale, purchase,
transportation, possession, concealment, or use of firearms, cutting instruments,
explosives, incendiary devices, or other deadly weapons
SAINT MARTIN’S UNIVERSITY
Campus Security Authority Reporting Form
Once completed, please send this form to:
[Attn: Director – Office of Public Safety, OM Rm 215]
Geography Definitions
On campus:
• any building or property owned or controlled by an institution within the same reasonably
contiguous geographic area and used by the institution in direct support of, or in a manner related
to, the institution’s educational purposes, including residence halls; and
• any building or property that is within or reasonably contiguous to the area identified in paragraph
(1) of this definition, that is owned by the institution but controlled by another person, is
frequently used by students, and supports institutional purposes (such as food or other retail
vendors)
Non-campus building or property:
• any building or property owned or controlled by a student organization that is officially recognized
by the institution; or
• any building or property owned or controlled by an institution that is used in direct support of, or
in relation to, the institution’s educational purposes, is frequently used by students, and is not
within the same reasonably contiguous geographic area of the institution
Public property:
• all public property, including thoroughfares, streets, sidewalks, and parking facilities, that is
within the campus, or immediately adjacent to and accessible from the campus
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Campus Security Authority Reporting Form If multiple incidents (St. Martin's College)

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Completed 27 August 2020

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