Incident Report Form
Incident Type
Definition
Examples
Fraud
Wrongful or criminal deception intended to result in financial or personal gain.
Billing for services not provided, billing for work already completed, investment schemes.
Telecommunication Harassment
Unwanted phone calls or messages of an annoying, harassing or threatening nature. Repeated Hangups
Immediate hang-ups, obscene language, etc. with no known suspects.
Identify theft
Obtaining someone else's personal identifying information and using it to obtain credit, goods or services. Stealing your identity
Someone obtains a credit card using your S.S.N. or obtains phone service using your personal information.
Lost Property
When property is missing or lost.
Property that is missing, leaving items in restaurant, or missing from home.
Property Damage (Accidental)
Minor property damage which is not criminal in nature under $500 loss. (Does not include vehicle crashes)
Damage of personal property without criminal intent.
Theft (Non-Vehicle)
Your property is taken or attempted to be taken without your permission. (Other than forced entry into property)
Property known to be stolen, or attempted to be stolen may be reported. Stolen bicycles, lawn furniture, tools, etc. (If taken from forced entry into your home, call for police dispatch)
Theft (Vehicle-Related)
Property is stolen from a motor vehicle or attempted theft of a motor vehicle. (Actual stolen vehicles can not be reported on this form)
Stolen equipment or belongings from a vehicle, attempted stolen vehicles, etc.
Theft (Gas Drive Off)
Property (fuel) is stolen from a service station, convenience store etc.
Shopper adds fuel to automobile tank, portable container, etc., and leaves business without making payment.
Vandalism
The intentional act of changing, modifying or defacing public or private property.
Graffiti, knocking over mail box, throwing rock through windows, etc.
Offense Type
*
Fraud
Telecommunication Harassment
Identity Theft
Lost Property
Property Damage (Accidental)
Theft (Non-Vehicle)
Theft (Vehicle Related)
Theft (Gas drive-off)
Vandalism
Offense Date(s)
Beginning Date
*
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Beginning Time
*
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End Date
*
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Incident Location
*
Victim Information
Name
*
Date of Birth
*
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Address
*
Phone Number
*
Email Address
Suspect Known to Victim?
- None -
No
Yes
Describe Relationship to Victim
*
Suspect Information
If there is more than one suspect, you may enter the additional name(s) and contact information in the Description of Incident box below.
Suspect Name
*
Suspect Address
Suspect Phone Number
Vehicle Information
License Plate Number
State
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
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Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Make
Model
Color
Year
Month
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Property Information
You may enter additional property information in the Description of Incident box below.
Quantity
Description
*
Make
Serial Number
Value
Description of Incident
*
Is there evidence to be collected?
No
Yes
Attachments
Upload files pictures or files that may be helpful to investigators.
Files must be less than
15 MB
.
Allowed file types:
gif jpg jpeg png tif txt html pdf heic
.
File Sharing URL
Enter a file sharing URL (web address), such as an iCloud Link from iPhone Photos or a link from Google Photos.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Math question
*
1 + 1 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.