Campus Security Authority Incident Report Form

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Campus Security Authority Incident Report Form

This form is to be used by identified campus security authorities who are required under the federal Clery Act to report information they receive about crimes. The information collected from these forms will be used to compile statistics to be included in the campus Annual Security Report. For more information about Campus Security Authority responsibilities and the crime reporting process, please contact Susan Bronstein, Executive Director of Human Resources of College-Wide Safety, via e-mail or at 716.338.1035.

Numbers only. Please omit spaces and dashes.
Please provide as much information regarding the incident as you know. Do not identify the victim or other individuals involved in the incident.
Please select the category that best fits the description of the incident you are reporting.
Please answer the following if the incident was a sex offense:
What best describes the location of the incident? If the incident occurred in multiple places, please check all that apply.
Check all that apply.