Campus Crime or Incident Report

  • This form should be completed by individuals identified as “Campus Security Authorities” who are required to report information they receive about specified crimes pursuant to the Jeanne Clery Act of 1990. These crimes include: Murder, Negligent Manslaughter, Aggravated Assault, Robbery, Auto Theft, Arson, Burglary, Sex Offenses, Dating Violence, Domestic Violence, Stalking, Weapon Law violations, Drug Abuse violations and Liquor Law violations. The information collected from these forms will be used to compile crime statistics for reporting in the IUP Annual Security and Fire Safety Report.

    Person Completing Report




     

    Date:

     

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    Report made by:


     

     
    Date and time the incident/crime occurred:

     

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    Identify building name, address, etc. Be as specific as possible
     

    The location where this incident occurred was:
    Sex Offenses

    Examples of sex offenses are rape, sodomy, sexual assault with an object, fondling, incest, and statutory rape.

    Was this crime a sexual offense?
    If yes, were the victim and the assailant acquainted?
    If yes, was either the victim or the assailant under the influence of alcohol or drugs?
    Victim
    Assailant
    Hate Crimes

    Hate crime information is required to be reported for each of the following crimes: criminal homicide, sex offense, robbery, aggravated assault, burglary, motor vehicle, theft, arson, simple assault, larceny, vandalism, intimidation, national origin, and gender identity. And for any other crime involving bodily injury.

    Was this incident motivated by hate or bias?
    If yes, identify the category of prejudice:


    If no, enter "NA."