SECURITY INCIDENT REPORT

INSTRUCTIONS: This report shall be completed by the person reporting or involved in the incident or the manager/supervisor. The completed report shall be delivered to Jake Petersen, CCS Director of Safety & Security, or sent electronically to PetersenJ@CascadeChristian.org no later than the end of the business day following the date of the incident. 

A SECURITY INCIDENT IS DEFINED AS: 

  • An incident placing a person or property at risk that requires action by law enforcement authorities or security personnel; or 
  • An incident placing a person at risk and involving a CCS employee during performance of their official duties or CCS student (including while employee or student is walking to or from an off-site parking facility at the start or end of the workday / school day); or 
  • An incident of a suspicious or unusual nature on CCS property that places people or property at risk; or 
  • An incident that occurred during non–business hours that affects the CCS workplace, students, and/or employees. 
I. INCIDENT DETAILS: 
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OTHER EMPLOYEES INVOLVED NOT LISTED IN SUMMARY OF INCIDENT (include phone number)
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OTHER PARTIES INVOLVED NOT LISTED IN SUMMARY OF INCIDENT (include phone number)
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II. LAW ENFORCEMENT / FIRE / EMS: 
WAS ANOTHER AGENCY CALLED TO RESPOND? *
If yes, check all that apply
 
WAS A REPORT FILED? *
III. INJURIES/TREATMENT: 
IV. ADDITIONAL COMMENTS: 
PERSON FILING REPORT: 
Signature *
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