Public Safety Report Form
Report a crime or information about a safety or security threat. Please note, this form is not monitored 24/7. In case of an emergency on an incident that needs immediate attention, please contact us by calling 301-447-5911.
Incident type (select all that apply):
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Alcohol Policy Violation
Drug Policy Violation
Computer Crime or policy violation
Harassment
Theft Vandalism
Murder
Non- Negligent Manslaughter
Manslaughter by Negligence
Rape
Fondling
Incest
Statutory Rape
Robbery
Aggravated Assault
Burglary
Motor Vehicle Theft
Arson
Domestic Violence
Dating Violence
Stalking
Hate Crime
Hate Crime – Larceny
Hate Crime - Simple Assault
Hate Crime – Intimidation
Hate Crime – Vandalism
Liquor Law Violation
Drug Law Violation
Weapons Law Violation
Other (provide explanation below)
Other (explain):
Safety / Security Threat
Safety Threat
Security Threat
Location where the crime occurred:
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Please Select
On campus
On campus residential building
Clinical Rotation Site – PA Program
Non campus
Public property
Private property
Other
Exact location the crime occurred:
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Date crime occurred:
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-
Month
-
Day
Year
Date Picker Icon
Approximate time:
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1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Suspect's name (if known include height and weight also):
Others involved:
Describe the incident. (Be specific as possible):
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Is this a this is a Campus Security Authority (CSA) report? If this is a CSA report, contact information must be provided for the CSA completing the report form.
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Yes
No
Email
*
Email (optional)
example@example.com
Name
*
First Name
Last Name
Name (optional)
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Phone Number (optional)
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Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Address (optional)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this an anonymous report?
Yes
No
Is this a voluntary, confidential report? (A voluntary, confidential report is when the victim of a crime wants to report the incident to Public Safety while complying with the victim’s wish to keep the matter confidential. The information in these reports will be used for statistical purposes for the annual security report and allows the university to take steps to enhance the future safety of the victim and others in the community.
Yes
No
Attachments (if applicable)
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