Incident Report

Incident Report

Use this online form to report an incident or crime that occurs on campus, in Otero resident housing, at a non-campus location, at an Otero sponsored event, or adjacent to campus property.
SECTION I

Contact and Incident Information

Please enter contact and incident information below.
Do you wish to remain anonymous? (If you wish to remain anonymous, you are not required to enter your name or phone number)*

YesNo
Name of Person Completing Report:

First NameLast Name
Phone Number

Area CodePhone Number
Date & Time Incident Occurred*

MonthDayYear
format: mm/dd/yyyyHourMinutesAM/PM Option
Incident Details (Check all that apply)*

MurderAggravated Assault/FightingBurglaryArsonMotor Vehicle TheftWeapons PossessionRapeStatutory RapeFondlingIncestSexual HarassmentStalkingDating ViolenceDomestic ViolenceHate CrimeMissing PersonInjury/Medical ConditionAccidentLiquor Law ViolationDrug Abuse ViolationSmoking/OdorsFire AlarmAccidentLarceny/TheftBullying/IntimidationVandalismDiscriminationHarassmentOther
Was the incident bias related?*

YesNoUnknown
If the incident was bias related, what was the bias based on? (Select all that apply)

SexGenderRaceColorAgeCreedNational or Ethnic OriginAncestryPhysical or Mental DisabilityFamilial StatusVeteran or Military StatusPregnancy StatusMarital StatusReligionGenetic InformationGender ExpressionGender IdentitySexual Orientation
Location of the Incident:*

On Campus: Grounds or Otero non-residential buildingsOn Campus Residential: Otero Student HousingOff Campus: During or in connection with an Otero sponsored program or activityOff Campus: In a building, structure or facility owned or controlled by OteroPublic Property: Property immediately adjacent to campus (includes sidewalks, streets, etc.)
Specific location and/or Address of Incident, If Known:

Street Address

City

Postal / Zip Code
SECTION II
Persons Involved in Incident or Crime (If Known)
1st Person Involved
2nd Person Involved
3rd Person Involved
4th Person Involved
5th Person Involved
6th Person Involved
7th Person Involved
8th Person Involved
9th Person Involved
10th Person Involved
SECTION III
Notifications

Please indicate who, if anyone, was notified about this incident or crime.
Was Law Enforcement Notified?*

YESNO
Law Enforcement Details
Date

MonthDayYear
Date
Time

:HourMinutesAM/PM Option
Case Number
Was Dean of Students Notified?*

YESNO
Was Title IX Coordinator Notified?*

YESNO
Was Residence Hall Director Notified?*

YESNO
Was Otero Security Notified?*

YESNO
SECTION IV
Description of Incident or Crime

Describe what happened in as much detail as possible and include consequences if applicable (e.g. law enforcement citation, arrest, discipline referral)
Describe what happened:*
Please check to see that all required fields are filled out before submitting the form. Required fields are indicated by an *.
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