CSA Report Form

CSA Responsibilities

If someone tells you about a crime or an incident that might be a crime, which occurred on or near ICOM Clery geography, you must report it to ICOM Campus Security either directly, or by completing this online form. If you have any questions about completing the report, please contact ICOM Campus Security at 208-795-4311.

A Campus Security Authority may not wait for criminal charges to be brought, arrests to be made, etc. Similarly, the CSA should not attempt to prove or decide whether the alleged incident actually occurred. The CSA must report even if the information regarding the incident was shared with him or her in confidence (confidentially), although he or she may report the information without identifying the people involved in the incident.

Completed CSA reports will be forwarded to the Director of Campus Security for appropriate action. Incidents which appear to be a Title IX violation will be forwarded to the ICOM Title IX Coordinator for investigation and follow-up.

Share the information as related by the person.

When in doubt, report.

Tell the person who disclosed the crime to you that you must share the information.

Help connect the person to available options and resources within the institution.

INFORMATION TO SHARE

Date, time, and location of the incident

Date and time the incident was reported to you

Description of the nature of the incident

Identities of individuals involved, including known suspects and witnesses, unless the reporting person requested confidentiality.

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* 1. Reporting CSA name

Lat Name

First Name

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* 2. Reporting CSA mobile number

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* 3. Reporting CSA email address

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* 4. Reporting party's name or personal identifier (such as their initials if they do not wish to disclose their name). If the incident involves a Title IX violation, the names of the parties involved must be disclosed to the Title IX Coordinator.

Last Name

First Name

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* 5. Date and time incident reported to CSA

Date / Time

Date

Time

AM/PM

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* 6. Location of incident

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* 7. Incident description (Please provide specific, detailed information.)

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* 8. Does the reporting party wish to inform law enforcement?

(The decision to notify law enforcement is entirely the decision of the victim. ICOM Campus Security will respect the wishes of the victim).

Yes

Unsure at this time

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* 9. Incident Category (see definitions below)

Homicide (indicate if murder/non-negligent manslaughter or manslaughter by negligence)

Sex Offense (indicate whether rape, fondling, incest, or statutory rape)

Aggravated Assault

Burglary

Robbery

Hate Crime

Dating Violence

Domestic Violence

Stalking

Motor Vehicle Theft

Arrest for Liquor Law Violation

Arrest for Drug Law Violation

Arrest for Weapons Law Violation

Referral for Liquor Law Violation

Referral for Drug Law Violation

Arson

I am unsure how to classify this incident

Other Crime Category (If the crime was not listed above, please enter the additional crime category)

CLERY ACT DEFINITIONS

Homicide
Murder/non-negligent manslaughter: the willful (non-negligent) killing of one human being by another
Manslaughter by Negligence: the killing of another person through gross negligence

Sex Offenses
Sex offenses: Any sexual act directed against another person without the consent of the victim, including instances where the victim is incapable of giving consent.

Rape: The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim
Fondling: The touching of the private body parts of another person for the purpose of sexual gratification, without the consent of the victim, including instances where the victim is incapable of giving consent because of his/her age or because of his/her temporary or permanent mental incapacity
Incest: Sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law
Statutory Rape: Sexual intercourse with a person who is under the statutory age of consent

Robbery

Taking or attempting to take anything of value from the care, custody, or control of a person or persons by force or threat of force or violence and/or by putting the victim in fear

Aggravated Assault
Unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury

Burglary
Unlawful entry of a structure to commit a felony or theft (does not apply to vehicles)

Motor Vehicle Theft
The theft or attempted theft of a motor vehicle

Arson
Willful or malicious burning or attempt to burn with or without the intent to defraud a dwelling house, public building, motor vehicle or aircraft, personal property of another, etc.

Dating Violence
Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim; and where the existence of such a relationship shall be determined based on a consideration of the following factors:

• the length of the relationship • the type of the relationship • the frequency of interaction between the persons involved in the relationship

Domestic Violence
Felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction...or by any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdiction

Stalking
Engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for his or her safety or the safety of others, or suffer substantial emotional distress

Liquor Law Violation
The violation of state or local laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession, or use of alcoholic beverages

Drug Law Violation
The violation of laws prohibiting the production, distribution and/or use of certain controlled substances and the equipment or devices utilized in their preparation and/or use

Illegal Weapons Possession
The violation of laws or ordinances prohibit

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* 10. Is there any evidence that this crime was motivated by bias?

Yes

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* 11. If yes, please choose any/all categories of prejudice that apply:

Race

Ethnicity

Disability

Gender

Gender Identity

Religion

National Origin

Sexual Orientation

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* 12. If you answered “yes” to the Motivated by Bias question, please provide a brief summary of the evidence supporting a bias motivation:

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* 13. Location (see location descriptions below)

What best describes the location of the crime? (If the crime occurred in multiple places, check all that apply. Please see the attached for further explanation as to the geography.)

On-campus (including ISU Anatomy Lab)

Non Campus Buildings or Property: While ICOM owns no off-campus property, it does provide temporary housing in several locations for ICOM students during their third year of clinical rotations. These locations are considered Non-Campus Properties for purposes of the Clery Act.

Public property within or immediately adjacent to campus

I do not know which category this location would fall under.

CLERY ACT GEOGRAPHY

On Campus
• any building or property owned or controlled by an institution within the same reasonably contiguous geographic area and used by the institution in direct support of, or in a manner related to, the institution’s educational purposes, including residence halls; and
• any building or property that is within or reasonably contiguous to the area identified in paragraph (1) of this definition, that is owned by the institution but controlled by another person, is frequently used by students, and supports institutional purposes (such as food or other retail vendors)

Non-Campus Buildings or Property
Any building or property owned or controlled by a student organization that is officially recognized by the institution; or any building or property owned or controlled by an institution that is used in direct support of, (or) in relation to, the institution’s educational purposes, is frequently used by students, and is not within the same reasonably contiguous geographic area of the institution. (Temporary housing provided by ICOM to students on clinical rotations is considered Non-Campus Buildings or Property).

Public Property
• all public property, including thoroughfares, streets, sidewalks, and parking facilities, that is within the campus, or immediately adjacent to and accessible from the campus

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* 14. Supporting Documents or Photos

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

CSA Report Form

CSA Responsibilities

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* 1. Reporting CSA name

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* 2. Reporting CSA mobile number

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* 3. Reporting CSA email address

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* 4. Reporting party's name or personal identifier (such as their initials if they do not wish to disclose their name). If the incident involves a Title IX violation, the names of the parties involved must be disclosed to the Title IX Coordinator.

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* 5. Date and time incident reported to CSA

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* 6. Location of incident

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* 7. Incident description (Please provide specific, detailed information.)

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* 8. Does the reporting party wish to inform law enforcement? (The decision to notify law enforcement is entirely the decision of the victim. ICOM Campus Security will respect the wishes of the victim).

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* 9. Incident Category (see definitions below)

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* 10. Is there any evidence that this crime was motivated by bias?

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* 11. If yes, please choose any/all categories of prejudice that apply:

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* 12. If you answered “yes” to the Motivated by Bias question, please provide a brief summary of the evidence supporting a bias motivation:

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* 13. Location (see location descriptions below)What best describes the location of the crime? (If the crime occurred in multiple places, check all that apply. Please see the attached for further explanation as to the geography.)

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* 14. Supporting Documents or Photos

* 8. Does the reporting party wish to inform law enforcement?

(The decision to notify law enforcement is entirely the decision of the victim. ICOM Campus Security will respect the wishes of the victim).

* 13. Location (see location descriptions below)

What best describes the location of the crime? (If the crime occurred in multiple places, check all that apply. Please see the attached for further explanation as to the geography.)