Security Incident Report

SECURITY INCIDENT REPORT

UNIFORMED SECURITY FORCE

Date of Report: / Date & Time of Incident: / Report No:
Type of Incident: (See Reverse) / Reporting Person: / Time Reported:
Location of Incident/Address:
COMPLAINANT/VICTIM INCIDENT INFORMATION
Name: Mr.___ or Ms.___ / Emergency Contact Person:
Home Address: / Home Phone:
Work Address: / Work Phone:
Describe Injury if Applicable:
Cause of Injury: (√ Appropriate Items) ___Falling Object ___Tripped ___Slipped ___Fell ___Other-
Type of Shoes Worn:
Condition of Area: (√ Appropriate Items) ___Wet ___Dry ___Flat ___Angled ___Light ___Dark ___Solid ___Soft
Medical Services Contacted: ___Yes or ___No / Responding Unit: / Transported To:
Property Description: (If necessary use narrative space)
Property Status: (√ Appropriate Items) ___Stolen ___Missing ___Damaged ___Recovered ___Other
Serial #: Estimated Value $:
SUSPECT INFORMATION #1 (S-1)
Name: Mr.___ or Ms.___
Barring Notice in Existence or Created: ___Yes or ___No / Hgt: / Wgt: / Approx Age:
Complexion: / Build: / Hair: / Eye Color:
Clothing Description:
Additional Information:
SUSPECT INFORMATION #2 (S-2)
Name: Mr.___ or Ms.___
Barring Notice in Existence or Created: ___Yes or ___No / Hgt: / Wgt: / Approx Age:
Complexion: / Build: / Hair: / Eye Color:
Clothing Description:
Additional Information:
WITNESS INFORMATION #1 (W-1)
Name: Mr.___ or Ms.___ / Written Statement Requested? ___Yes or ___No
Home Address: / Home Phone:
Work Address: / Work Phone:
WITNESS INFORMATION #2 (W-2)
Name: Mr.___ or Ms.___ / Written Statement Requested? ___Yes or ___No
Home Address: / Home Phone:
Work Address: / Work Phone:
Printed Name of Reporting Security Officer / Signature of Reporting Security Officer / Date/Time
Printed Name of Reviewing Supervisor / Signature of Reviewing Supervisor / Date/Time
Police Officer’s Name (If Applicable) / Badge No.

Complete Reverse Side

Narrative of Incident:

Use Continuation Page if Needed

Notifications (Fill in as appropriate)

Name/Unit # Date/Time Method of Notification

Immediate Supv or On Duty
Operations Security Base
Management (PM/AM)
Management (Corporate)
Communications
Fire Department/Ambulance
Police
Facilities
Other
Other

Examples of Incident Types:

A) Denied Access / B) Accident/Damaged Auto / C) Assaults (Physical or Verbal)
D) Bomb Threat / E) Disorderly Conduct / F) Alarm (Intrusion, Fire, etc.)
G) Weapon (Recovered, Discovered) / H) Medical Emergency / I) Personal Injury
J) Sexual Assault / K) Suspicious Activity / L) Stuck Elevator
M) Theft / N) Trespassing / O) Unauthorized Entry
P) Unleashed Animal / Q) Vandalism / R) Domestic Incident
S) Robbery / T) Security Breach / U) Policy/Procedure Violation
V) Harassment / W) Information/Observation / X) Other/Not listed

* Incident reports are to be completed by the end of the shift in which the incident occurred. The first security officer/supervisor on the scene or to be made aware of the incident is responsible for the report. Every report will be reviewed by the preparer’s supervisor. All reports are to be turned into the on-duty AOM at the end of each shift. Any incident where an employee is injured requires additional paperwork to be completed at bldg 45.

Security Incident Report Continuation Sheet

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