Incident Form

Our purpose is to make this campus safe and secure for all. We are all responsible to ensure that our valuables are secure and that crime and suspicious incidents are reported in a timely manner. It is vital we work together to identify and resolve problems that lead to crime or the fear of crime. All reports of crime, suspected criminal or suspicious activity should be reported to the SSC Police Department. Note:

This form will go only to the SSC Campus Chief of Police and the Vice President for Student Affairs.

Person Submitting Form

Name*
A value is required.Exceeded maximum number of characters.Minimum number of characters not met.

Phone*
A value is required.Invalid format.

Address

City

State Zip Invalid format.Exceeded maximum number of characters.

If student - Student ID# Invalid format.Minimum number of characters not met.Exceeded maximum number of characters.

Type of Person Submitting this form* SSC Employee SSC Student Visitor

Date of Incident* A value is required.Invalid format Time of Incident* A value is required.Invalid format. Date Reported*

Person of Concern

Name*
A value is required.Exceeded maximum number of characters.Minimum number of characters not met.

Phone
A value is required.Invalid format.

Address

City

State Zip Invalid format.Exceeded maximum number of characters.

If student - Student ID# Invalid format.Minimum number of characters not met.Exceeded maximum number of characters.

Type of Person of Concern* SSC Employee SSC Student Visitor

Description of Incident *

Witnesses ?

Incident Report Form

Person Submitting Form

Person of Concern