CLERY - CSA - INCIDENTREPORT FORM1docx 2026

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  1. Click ‘Get Form’ to open the CLERY - CSA - INCIDENTREPORT FORM1docx in our editor.
  2. Begin by filling in the 'Person Receiving Report' section with your name and phone number. This identifies who is reporting the incident.
  3. Indicate whether the report is made by the victim or a third party, and specify your relationship to the victim if applicable.
  4. Document the date and time of the incident in the designated fields to provide accurate context for your report.
  5. In the 'Description of the Incident or Crime' section, provide a detailed account of what occurred, ensuring clarity and completeness.
  6. Specify the location of the incident by selecting from options such as on-campus, off-campus affiliated property, etc., ensuring you choose accurately.
  7. Answer questions regarding whether it was a sex offense and if hate motivation was involved, providing additional details where necessary.
  8. Complete any sections related to alcohol, drug, or weapons violations by checking applicable boxes and describing any relevant details.
  9. Finally, sign and date the form at the bottom before submitting it to ensure all information is officially recorded.

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CSAs are not responsible for determining authoritatively whether a crime took place. If you are unsure for any reason whether an incident should be reported, please report the incident.
The Clery Act requires colleges and universities that receive federal funding to publish, distribute, and disseminate an annual security report (ASR) to current and prospective employees and students by October 1 each year. Most institutions make it available through their website.
A Campus Security Authority is a mandated reporter to the Clery Compliance Office or other designated University office for reported allegations of Clery Act crimes for inclusion in the annual disclosure of crime statistics.
A Campus Security Authority (CSA) is an individual, who by virtue of their university responsibilities and under the Clery Act, is designated to receive and report criminal incidents to the Department of Public Safety (DPS) or the Office of Clery Act Compliance so that they may be included and published in the
A campus security authority is a person that has a duty to report a crime and take action on behalf of the institution when it is reported. The Clery Act defines a CSA as: A campus police department or a campus security department of an institution.

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