Fillable Printable Clery Incident Report - California
Fillable Printable Clery Incident Report - California
Clery Incident Report - California
CALIFORNIA STATE UNIVERSITY, LONG BEACH CAMPUS SECURITY AUTHORITY
CLERY INCIDENT REPORT
One important purpose of the Clery Act is to encourage the accurate collection of campus crime statistics in order to promote and enhance campus crime awareness
and campus safetythrough reliable statistical crime reporting. The purpose of this report form is to provide Campus Security Authorities (CSAs) with a uniform
mechanism for documenting the (who, what, when, where) of crimes reported to them, especially, confidential reporting.
Clery provides the following definitions for reporting locations.
1)
On-campus property: Anybuilding or property owned or controlled by the University within the same reasonably contiguous geographic area and used
by the University in direct support of, or in a manner related to, the University's educational purpose, including any buildings or property that is owned by
the University but controlled by another person and which is frequentlyused bystudents and supports institutional purposes such as a food or other retail
vendor. (Excluding Residential Colleges)
2)
On-campus Residential Colleges. (Hillside and ParksideColleges)
3)
Non-campus property: Any building owned or controlled bya student organization that is officially recognized by the University; or anybuilding or
property owned or controlled by the University that is used in direct support of, or in relation to theUniversity’s educational purposes, is frequently used by
students, and is not within the same reasonably contiguous geographic area of the University (includes Beachside/Blair Field/Greeks/Foundation, etc.).
4)
Public property: All public property, including: thoroughfares, streets, sidewalks, parking facilities, that is within the campus, or immediatelyadjacent to
and accessible from campus.
5)
Off campus: Locations not included above.
Data collected on this form shall not include personal identifying information. The studentstatus of the offender or victim is not a relevant fact when determining if a
report should be accepted. All reports involving any of the listed crimes must be documented and reported to the University PoliceDepartment. The annual
Clery statistical count shallbe determined by the University Police Department. Use a separate report form for every Clery reportable incident; if in doubt
…
file a report.
A Campus Security Authority (CSA) is defined in the Annual Clery Report and on the reverse sideof this form.
Homicide
Aggravated Assault
Burglary (excluding auto burglary)
Domestic violence
Manslaughter
Sex Offense (Rape)
Motor Vehicle Theft
Dating violence
Robbery
Sexual Battery (Fondling)
Arson
Stalking
Hate Crime (In conjunction with above and/or below listed incidents):
Bodily injury
Vandalism
Intimidation
Theft
E-messaging
Telephone
Other
Include category
Gender Identity
Disability
of Bias:
Race
Ethnicity/national origin
Gender
Sexual Orientation
Religion
Locationof Incident:
On-campus (excluding student housing)
On-campus (student housing)
Off campus
Public property (adjacent to campus)
Unknown location
Non-campus property (
Beachside
/Blair/Greeks)
Date of Incident: Time of Incident: CSA Tracking#:
Name of CSA receiving report:CSULB Department/Unit:
Date report received: Time report received:
CSA received report from:
Victim
Witness
Friend
Offender
Family
Other
Police Report filed?
Yes
No
Unk.
Date/time reported to
Police Department:
CSULB PD Case#: (If known)
Other PD & #
Sex Offense: Sex offenses are of special concern to the campus community because historically they have been under reported. The victim of a sex
offense typically desires confidentiality and anonymity; as a result he/she will often seek a reporting source other than law enforcement such as a designated
Campus Security Authority. Because the sex offender maycontinue to pose a threat to the community, the threat potential needs to be quicklyevaluated
and the campus community alerted/warned as deemed necessary. In this regard, the followingadditional information is requested.
Sex Offense:
Victim: (
student
faculty
staff
other )
Known offender: (
friend
classmate
acquaintance
date other)
Unknown offender: (stranger)
Victim was NOT physically injured (excluding emotional/psychological trauma)
Victim was physically injured
Describe injuries: ________________________________________________
Sex Offense:
Alcohol involved:
Offender
Victim
Drugs/narcotics involved:
Offender
Victim
Weapon involved:
Yes
No
Describe weapon:
Description of Offender:
Race: Gender: _ Age:
Height:___ Wt: Hair Color:___
Eye Color:
PhysicalCharacteristics:
Brief Description of Crime:
Definitions
Criminal Homicide (Manslaughter by Negligence)
The killing of another person through gross negligence.
(Attempts are classified as aggravated assaults)
Criminal Homicide (Murder and Non-negligent Manslaughter)
The willful (non-negligent) killing of a human being by another.
(Attempts are classified as aggravated assaults)
Robbery
The taking or attemptingto take anything of value from the care,
custody, or control of a person(s) by force or threat of violence
and/or fear
Aggravated Assault
An unlawful attack of another for the purpose of inflicting severe or
aggravated bodily injury accomplished by the use of a weapon or
means likely to produce death or great bodilyharm. It is not
necessary that an injury results when a gun, knife or other weapon
was used but which could have resulted in serious injury. (Includes
attempts)
Burglary
The unlawful entry (or attempt to enter) into a defined structure
with the intent to commit a theft or any felony.
(Includes attempts, but excludes vehicle burglary.)
Motor Vehicle Theft
Taking of a motor vehicle (as defined) without the consent of the
owner with the intent to either permanently or temporarily
deprive the owner of the vehicle. (Includes attempts and joyriding)
Sex Offense (Rape)
Any sexual act directed against another person without their
consent or against an incapacitated person (Includes attempts)
a.
Penetration, no matter how slight, of the vagina or anus with any
body part or object, or oral penetration by a sex organ of
another person, without the consent of the victim.
b.Incest (sexual intercourse between persons who are related
to one another within the degrees wherein marriage is
prohibited)
c.
Statutory rape (consensual intercourse with a person who
is under the age of consent - 18yrs)
Sexual Battery (Fondling)
a.
Sexual battery (the touching of the intimate parts: sexual
organ, anus, groin, or the breast of a female)
Arson
The willful or malicious burning or attempt to burn (w/o the intent
to defraud) a dwelling house, public building, motor vehicle or
aircraft, or personal property of another, etc. (Includes attempts)
Domestic Violence (Sec. 40002(a), VAWA (42 USC 13925(a)(8))
Includes 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 the victim as a spouse or intimate
partner, by a person similarly situated to a spouse of the victim
under the domestic or family violence laws of the jurisdiction
receiving grant monies, 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.
Dating Violence (Sec. 40002(a), VAWA (42 USC 13925(a)(10))
The term “dating violence” means violence committed by a person:
(A)
who is or has been in a social relationship of a romantic or
intimate nature with the victim; and (B) where the existence of
such a relationship shall be determined based on a consideration of
the following: (i) length of the relationship,
(ii)
type of relationship
(iii)
frequency of interaction between the persons
involved in the relationship
Stalking (Sec. 40002(a), VAWA (42 USC 13925(a)(30))
The term “stalking” meansengaging in a course of
conduct directed at a specific person that would cause a reasonable
person to:
(A)
Fear for his/her safety or the safety of others; or
(B)
suffer substantial emotional distress
Hate Crime
A criminal act involvingone/more of the previous or below
listed crimes which was motivated by biasagainst any
person or group of persons, or the property of any person or
group of persons because of the ethnicity, race, national
origin, religion, gender, sexual orientation, or disability of the
person or group, or biasbased upon the perception that the
person or group has one or more of those characteristics.
Larceny-Theft (Except Motor Vehicle Theft)
The unlawful taking, carrying, leading, or riding away of
property from the possession or constructive possessionof
another. Attempted larcenies are included. Embezzlement,
confidence games, forgery, worthless checks, etc., are excluded.
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, lossof 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 displayinga weapon or subjecting the
victim to actual physical attack.
Destruction/Damage/Vandalism of Property
To willfully or maliciously destroy, damage, deface, or
otherwise injure real or personal property without the consent
of the owner or the person having custody orcontrol of it.
DEFINITION OF CAMPUS SECURITY AUTHORITY (CSA)
a.
A police department or security department of the university.
b.
Any individual who has responsibility for campus security but
who does not constitute a campus police department or the
campus security department (e.g. parking enforcement staff,
communityservice officers, contract security).
c.
Any individual or organization specified in the University’s
statement of campus security policy as an individual or
organization to which students and employees should report
criminal offenses.
d.
Any official of the University who has a significant responsibility
for student and campus activities (e.g. Dean of Students; Student
Judicial Affair’s Officer; Directors of Campus Community
Centers; Director of Student Housing; RCCs; ARCCs; RAs;
Director of Athletics and team coaches; Coordinators directors
and/or advisors to student organizations, programs, activities,
campus recreation, Greek Affairs; etc.).
INSTRUCTIONS
a.
If the reported incident constitutes a threat to the safety of the
CSULB community, the CSA shall immediately telephone the
University Police Department at (562) 985-4101. If the
reporting party is a victim of a sex offense, the victim should be
encouraged to report the crime directly to the University Police
Department. The CSA must file a Clery Report.
b.“Good faith” confidential, second hand or anonymous reports
must be accepted and the CSA must file a Clery Report.
c.
The potential for duplication of reported crimes is not to be a
factor in determining whether or not a report is received.
d.
This reporting form does not replace or change any existing
reporting requirements or procedures established for
disciplinary referrals for student or employee misconduct.
e.
Hate crimes present a special reporting challenge, because Clery
also requires the recording of a“category of bias” that is
associated with the reported hate crime incident.
Send report: Please scan/email front page t o c le ry @ u p d . c su l b . e d u , fax to
(562) 9 85 -7796, or submit in person all Clery Incident Reports to CSU Long
Beach Police Department. Questions about this report or the Clery Act should also
be directed to c le ry @ u p d . c s u l b. e d u . ( R e v 1 0 / 1 4 )
