CSA Reporting Form

Campus Security Authorities (CSAs) can use this form to report incidents. This form is not for general student use, it is intended for trained Campus Security Authorities.

For incidents requiring an immediate police response, contact the Taft Police Department at 661-763-3101 or by calling 911 if appropriate.

Complete this form as soon as possible but no later than the next business day after the incident was reported to you.

"*" indicates required fields

Header Information

MM slash DD slash YYYY
If multiple incidents were reported or if the date of occurrence is unknown, please note that in the Incident Information section below.
MM slash DD slash YYYY
Name of Campus Security Authority
Email*

Reporting Party (R/P) or Victim Contact Information

Reported By:

R/P Name
If a third party (e.g. roommate, friend, parent) reported the crime to you, please enter the relationship of the third party to the victim:

Agency Notified

If, to your knowledge, a law enforcement agency was notified, please enter the name of that agency.
Does the victim want the incident reported to law enforcement?

Incident Information

Building name, street address, office number, room number, etc. (see location details below).
Please provide specific, detailed information.

Incident Classification

Incident Category

Is there any evidence this crime was motivated by bias?
If yes, please choose any/all categories of bias that apply
If you answered "yes" to the Motivated by Bias question, please provide a brief summary of the evidence supporting a bias motivation:
Location Details
What best describes the location of the crime? If the crime occurred in multiple places, check all that apply.