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- Police Incident Report Template

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OFFENSE/INCIDENT REPORT
IF ADDITIONAL SPACE
IS NEEDED, USE REVERSE OF FORM; IDENTIFY ITEMS.
1. TYPE
a. ORIGINAL b. CONTINUATION c. SUPPLEMENT
OR FOLLOWUP
2. CODE NO.
2a. SORT
3. TYPE OF OFFENSE OR INCIDENT
4. CASE CONTROL NUMBER
5. BUILDING NUMBER
7. NAME OF AGENCY/BUREAU
8. AGENCY/BUREAU CODE
9. SPECIFIC LOCATION
10. LOCATION CODE
11a. DATE OF OFFENSE/INCIDENT
11a. TIME OF OFFENSE/INCIDENT
12. DAY
13a. DATE REPORTED
13b. TIME REPORTED
14. DAY
15. JURISDICTION (X)
EXCLUSIVE CONCURRENT PARTIAL PROPRIETARY
16. NO. OF DEMONSTRATORS
17. NO. EVACUATED
a. TIME START
b. TIME END
18. PERSONS
INVOLVED
ID CODE
(a)
NAME AND ADDRESS
(b)
AGE
(c)
SEX
(d)
RACE
(e)
INJURY CODE
(f)
TELEPHONE
(g)
Last Name, First, Middle Initial
HOME
Number, Street, Apt. No., City and State
BUSINESS
Last Name, First, Middle Initial
HOME
Number, Street, Apt. No., City and State
BUSINESS
19. VEHICLE
a. STATUS
b. YEAR
c. MAKE
d.
MODEL
e. COLOR (Top/Bottom)
f. IDENTIFYING CHARACTERISTICS
STOLEN
SUSPECT
g. REGIS-
TRATION
►
YEAR
STATE
TAG NO.
h. VIN
i. VALUE
GOV’’T
PERSONAL
VANDALIZED
RECOVERED
20. ITEMS TAKEN
a. NAME OF ITEM
b. QUANTITY
c. OWNERSHIP
GOV’T PERSONAL
d. BRAND NAME
e. SERIAL NO.
f. COLOR
g. MODEL
h. VALUE
i. UNUSUAL OR UNIQUE FEATURES
j. PROPERTY WAS
SECURRED UNSECURED
k. STATUS OF PROPERTY
RECOVERED MISSING PARTIAL RECOVERY
VALUE RECOVERED
l. NAME OF ITEM
m. QUANTITY
n. OWNERSHIP
GOV’T PERSONAL
o. BRAND NAME
p. SERIAL NO.
q. COLOR
r. MODEL
s. VALUE
t. UNUSUAL OR UNIQUE FEATURES
u. PROPERTY WAS
SECURRED UNSECURED
v. STATUS OF PROPERTY
RECOVERED MISSING PARTIAL RECOVERY
VALUE RECOVERED
21. NARRATIVE (If additional space is needed, use blank sheet and attach.)
GENERAL SERVICES ADMINISTRATION
GSA FORM 3155 (REV. 3/200)
22. NOTIFICATION
TIME
23a. EVIDENCE
YES NO
23b. TAG NO.
23c. TYPE
NOTIFIED
ARRIVED
a. Other Police
Agency
23d. WHERE STORED
b. Fire Department
24. ATTACHMENTS (Mark “X” where applicable)
a. CONTINUATION SHEET
d. STATEMENT(S)
c. Ambulance
b. GSA FORM 3157
c. PROPERTY RECEIPT(S)
e. SUPPLEMENTAL
d. Building Manager
f. OTHER ATTACHMENTS (Specify)
e. OTHER (Specify)
25. SUSPECT STATUS
26. DISPOSITION OF SUSPECT
a. NOT IDENTIFIED
a. ARRESTED
b. NOT ARRESTED
b. GOVERNMENT EMPLOYEE
c. RELEASED
d. N/A
c. GOVERNMENT CONTRACT
d. CITATION ISSUED
►
CITATION NUMBER
d. NON-GOVERNMENT EMPLOYEE
e. N/A
NOTE: Complete GSA Form 3157 where this is a Suspect, Att. Burglary, Burglary, Att. Robbery, Robbery, or a Weapon is used.
27. TIME
28. REVIEWED BY
a. RECEIVED
b. ARRIVED
a. TYPE
FPS
GG
b. SIGNATURE
d. DATE
c. RETURNED TO SERVICE
c. NAME (Printed)
29a. BADGE
29b. NAME (Printed)
29c. SIGNATURE
29d. DATE
30. CASE REFERRED TO
31. CASE
32. APPROVING OFFICIAL
a. FPS DETECTIVE
b. LOCAL POLICE
c. STATE POLICE
a. SIGNATURE
b. DATE
d. FBI
e. IG
f. N/A
a. OPEN
g. OTHER (Specify)
b. CLOSED
c. NAME (Printed)
c. UNFOUNDED
33. DETECTIVE STATUS
a. CASE NUMBER
b. HOW CLOSED
INACTIVE ARREST OTHER MEANS
c. SUSPECT
DEVELOPED ARRESTED
d. ENTERED NCIC
YES NO N/A
e. PROPERTY
RECOVERED
f. VALUE OF PROPERTY
g. CLEARED NCIC
YES NO N/A
h. REFERRED TO
i. DATE REFERRAL ACCEPTED
21. NARRATIVE (If additional space is needed, use blank sheet and attach.)
GSA FORM 3155 (REV. 3/200) PAGE 2
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Completed 16 May 2022

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