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:

DATE OCCURRED * +

TIME OCCURRED (24HR) *

DATE COMPLETED * +

REPORTING PARTY *

ASSOCIATED CAMPUS *

ADDRESS OF INCIDENT (if different)

SUMMARY OF INCIDENT (briefly describe the incident here; include full names-first and last) *

OTHER EMPLOYEES INVOLVED NOT LISTED IN SUMMARY OF INCIDENT (include phone number)

+-

OTHER PARTIES INVOLVED NOT LISTED IN SUMMARY OF INCIDENT (include phone number)

+-

II. LAW ENFORCEMENT / FIRE / EMS:

WAS ANOTHER AGENCY CALLED TO RESPOND? *

Yes

No

If yes, check all that apply

Law Enforcement

Fire

EMS

Other Other

WAS A REPORT FILED? *

Yes

No

OFFICER FILING REPORT (include badge ID number)

III. INJURIES/TREATMENT:

NATURE OF INJURY

LOCATION OF INJURY

TREATMENT RECEIVED (if any)

IV. ADDITIONAL COMMENTS:

ADDITIONAL COMMENTS:

PERSON FILING REPORT:

First name, last name *

Phone Number *

Email *

Signature *

clear