Campus Security Authority Incident Report Form

Campus Security Authority Incident Report Form

Clery Act and California Ed Code 67380-67383 Compliance

As a CSA, your responsibility is to gather and report basic information. Please complete all fields of this form, to the best of your ability, with as much detail as possible. A CSA may not choose to be anonymous when making a report.

This form is intended as a guide to assist a Campus Security Authority (CSA) in gathering information for reporting, in compliance with the Clery Act and California Education Code. CALL 909-652-6911 IMMEDIATELY if you are concerned for the safety of any of the involved parties or other members of the community.

The Clery Act requires reporting of crimes without unnecessary delay.

It is critical in incidents involving a violent crime, sexual assault, or hate crime (or attempts of these crimes) that the CSA ask victims if they want to report the incident directly to the police for investigation. If so, the CSA must report the crime immediately or as soon as practicably possible, per California Education Code 67380-67383. Call the Chaffey College Police Department (Campus Police) at 909-652-6911 and ask for an officer to contact you. In all cases, Campus Police will assist, even if the crime occurred off campus. Neither the California Education Code nor the Clery Act require CSAs to report names of victims or suspects.

NOTE: The CSA must also contact the Title IX office if the incident being reported is a sexual assault or any incident that involves prohibited sexual conduct. Call 909-652-6531 to reach the Title IX Office. (This number is not answered 24/7; after-hours messages will receive return calls promptly.)

REPORTABLE CRIMINAL OFFENSES:

Murder/Non-Negligent Manslaughter: the willful (non-negligent) killing of one human being by another.

Manslaughter by Negligence: the killing of another person through gross negligence.

Rape: the penetration, however slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ, without consent, including when the victim is incapable of giving consent (includes the rape of both males and females).

Fondling: the touching of the private body parts of another person for the purpose of sexual gratification, without consent, including when the victim is incapable of giving consent.

Incest: sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law (in California: parents and children, ancestors and descendants of every degree, brothers and sisters of any degree — including half-brothers and half-sisters — and uncles or aunts with nieces or nephews).

Statutory Rape: sexual intercourse with a person who is under the statutory age of consent (in California: under 18). (Note: If force is used or threatened, or the victim was incapable of giving consent because of his/her age or temporary or permanent or mental impairment, the offense is Rape, not Statutory Rape).

Robbery: the taking or attempting to take anything from 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.

Aggravated Assault: an unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury. This type of assault usually is accompanied by the use of a weapon or by means likely to produce death or great bodily harm.

Burglary: the unlawful entry of a structure to commit a felony or a theft. (A structure has four walls, a roof, and a door.)

Motor Vehicle Theft: the theft or attempted theft of a motor vehicle. (Classify as motor vehicle theft all cases where automobiles are taken by person not having lawful access, even though the vehicles are later abandoned - including joy riding).

Arson: any willful or malicious burning or attempt to burn, with or without intent to defraud, a dwelling house, public building, motor vehicle or aircraft, or personal property of another.

HATE CRIMES:

Chaffey College is also required to report statistics for hate (bias) related crimes by the type of bias as defined below for the following classifications: murder/non-negligent manslaughter, negligent manslaughter, sex offenses (forcible and non-forcible), robbery, aggravated assault, burglary, motor vehicle theft, arson (see definitions above) and larceny, vandalism, intimidation, and simple assault (see definitions below).

A hate or bias-related crime is not a separate, distinct crime, but is the commission of a criminal offense which was motivated by the offender's bias. For example, if a subject assaults a victim, it is a crime. If the facts of the case indicate that the offender was motivated to commit the offense because of his bias against the victim's race, sexual orientation, etc., the assault is then also classified as a hate crime.

Larceny: the unlawful taking, carrying, leading, or riding away of property from the possession or constructive possession of another. (Constructive possession is the condition in which a person does not have physical custody or possession but is in a position to exercise dominion of control over a thing.)

Simple Assault: an unlawful physical attack by one person upon another where neither the offender displays a weapon, nor the victim suffers obvious severe or aggravated bodily injury involving apparent broken bones, loss of teeth, possible internal injury, severe laceration or loss of consciousness.

Intimidation: to unlawfully place another person in reasonable fear of bodily harm through the use of threatening words and/or other conduct, but without displaying a weapon or subjecting the victim to actual physical attack.

Destruction/Damage/Vandalism of Property: to willfully or maliciously destroy, injure, disfigure, or deface any public or private property, real or personal, without the consent of the owner or person having custody or control by cutting, tearing, breaking, marking, painting, drawing, covering with filth, or any other such means as may be specified by local law.

VAWA OFFENSES:

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 (i.e., domestic partnership), 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 where the crime occurred.

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:(i) the length of the relationship; (ii) the type of relationship; (iii) the frequency of interaction between the persons involved in the relationship.

Stalking: engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for the person’s safety or the safety of others; or suffer substantial emotional distress.

ARRESTS AND REFERRALS FOR DISCIPLINARY ACTION:

Weapon Law Violations: the unlawful possession or control of any firearm, deadly weapon, (including nunchakus or billy club) illegal knife or explosive device while on college property, except as required in the lawful course of business or as authorized by the Campus Police; the unlawful manufacture, sale, purchase, transportation, possession, concealment, or use of firearms, cutting instruments, explosives, incendiary devices or other deadly weapons.

Drug Law Violations: the unlawful possession, sale, use, transportation, growing, cultivation, manufacturing, making, distribution, purchase, importation of any controlled drug or narcotic substance; violations of laws prohibiting use of the equipment or devices utilized in their preparation and/or use.

Alcohol Law Violations: the unlawful possession, sale, transportation, manufacturing, purchase, or use of alcoholic beverages; furnishing alcohol to a minor (under 21 years); maintaining unlawful drinking places; bootlegging; operating a still; using a vehicle for illegal transportation of liquor; drinking on a train or public conveyance; and attempts to commit any of the above. (Drunkenness and driving under the influence are not included in this definition.)

CSA INFORMATION

Name of CSA:

First Name

Last Name

CSA Position Title / Department

CSA Phone

CSA Email

CRIME DETAILS

Date and Time of Crime (or approximate time frame):

:

Date and Time Reported to CSA:

:

Crime Location

Provide the building name, parking lot number, street name or cross streets, or nearby buildings
Please be specific as to where the incident is reported to have occurred (i.e. inside a classroom or office on-campus, in a common area inside a building, outside a building, etc.).

CRIME OFFENSE - If a Hate Crime occurred, please check "Hate Crime" as well as the crime that occurred.

Hate Crime Bias : (Check only if you selected Hate Crime above in addition to the underlying crime. Check all that apply – requires one or more of the following biases):

Race Gender

Religion Sexual Orientation

Ethnicity Gender Identity

National Origin Disability

How did you as the CSA become aware of the crime?

From the Victim

From a Third Party

I Personally Witnessed the Crime

Be sure to ask the victim the following question and document the response. Do you want to contact the police and have this matter investigated by law enforcement?

Yes No

CONSENT TO INCLUDE PERSONALLY IDENTIFYING INFORMATION Victim confidentiality: CSAs may not, according to California law, identify the victim to Campus Police unless the victim consents to being identified after being informed of his or her right to have his or her Personally Identifying Information (PII) withheld.

The victim has provided consent to include Personally Identifying Information (PII) in this CSA Report.

INCIDENT SUMMARY Please include a detailed description of the crime, incident, or disciplinary referral in the space below. Please list the name of the victim involved in the incident if the box above is checked. Please list the name of the victim involved in the incident if the consent box above is checked.