Campus Security Authority Incident Reports

Campus Security Authority Reporting

Collection of crime statistic not previous reported to law enforcement.

This form is to be used by individuals identified as a “Campus Security Authority” who are required under the Clery Act, a federal law, to report information they receive about crimes. The information collected from these forms will be used to compile statistics to be included in the campus' Annual Security and Fire Safety Report.

Do you have any Clery crimes to report to Miami University Police?

No, I do not have any crime(s) to report at this time. All crimes reported to me were immediately reported to law enforcement.

No, I do not have any crime(s) to report at this time.

Yes, I have crime(s) to report at this time

CSA Incident Report

Which Campus are you reporting for? - please choose one campus only.

Oxford Hamilton Middletown Voice of America Learning Center Luxembourg Cincinnati Other

Other - Which Campus are you reporting for?

Beginning Date/Time the Incident Occurred

Beginning Date/Time the Incident Occurred - UTC

Ending Date/Time the Incident Occurred

Ending Date/Time the Incident Occurred - UTC

Date/Time Incident Report to CSA

Date/Time Incident Reported to CSA - UTC

Location of Incident - please choose one from the list below:

On Campus

On Campus, Residence Hall

Non Campus Property (owned, controlled, or affiliated with campus; eg leased property, fraternities)

Public Property Immediately adjacent to campus (sidewalk, street, sidewalk which adjacent to campus)

Off Campus - not affiliated or adjacent to campus

Unknown

Location of Incident - please choose one from the list below - Lux

On Campus

On Campus, Residence Hall

Non Campus Property (owned, controlled, or affiliated with campus; eg leased property, fraternities)

Public Property Immediately adjacent to campus (sidewalk, street, sidewalk which adjacent to campus)

Off Campus - not affiliated or adjacent to campus

Unknown

Type of Incident - please choose all incident that apply.

Briefly describe the incident.

Was anyone physically injured? Was hospitalization or other medical treatment required?

Are the victim's parents/family members aware of the incident?

Is the suspected perpetrator a Miami Student?

Was the incident reported to local law enforcement (police)?

If the incident poses an immediate threat to the health or safety of students or employees...

Does the incident represent an on-going serious or continuing threat to the Luxembourg campus community? If so, has a campus crime alert been issued? (contact Miami University Police Department,- 513-529-2222, for assistance.)

Do you have any reason to belive this act was motivated by prejudice?

Hate Crime Details

Please identify the type of prejudice - check all that apply

If the incident was motivated by hate.

Reports Information (from whom did you learn about this reported crime)

First and Last Name

Phone Number

Email

Your name

Your email address

Your phone number

Verification Code

Campus Security Authority Incident Reports

Campus Security Authority Reporting

CSA Incident Report

Hate Crime Details

Reports Information (from whom did you learn about this reported crime)

Other Fields