Report Number:

Assigned to:

Date of Call : (YYYY-MM-DD) AM PM

Your Name:

Your Phone Number:

Title:

Agency:

Outcome (s):

Continuing to Monitor Situation
Ongoing Investigation
Prevention
Arrest
Counseling
School Disciplinary Action
Not Enough Information
Citation
Parents Notified

Other:
How was the situation handled?


Outcome of Incident (please describe):


Alcohol Involved: Yes No

Alcohol Recovered:

Drugs Involved: Yes No

Drugs Recovered:

Drugs Description (Type, Amount):

Value:


Weapons Involved: Yes No

Weapons Recovered:


Weapons Description (Type):

Value:

Property Involved: Yes No

Property Recovered:


Property Description (Kind, Amount):

Value:


Please provide feedback on the quantity of information received and your recommendations for improvements.