Campus Security Authority Reporting Form

The CSA Reporting Form is intended to provide Campus Security Authorities (CSAs) with a method of reporting Clery crimes to Public Safety for inclusion in the University's annual compilation of statistics related to crimes that occur on campus and other University-owned or controlled property. The collection of this information is required by the Clery Act.

The Clery Act defines four categories of CSA:

  • Public safety employees
  • Employees who have responsibility for campus security but who are not employees of the public safety department
  • Employees who have significant responsibility for student and campus activities, including, but not limited to, student housing, student discipline and campus judicial proceedings
  • Employees who are specified in the campus Annual Security Report as individuals to whom students and employees should report criminal offenses

The CSA Reporting Form is NOT a method of notifying police of an emergency, dangerous situation or other hazard. The submission of the CSA Reporting Form will NOT prompt a police investigation or generate an official police report or case number.

Public Safety personnel evaluates each CSA report to determine if the incident reported requires the publication of a timely warning notice or emergency notification to the campus community.

The intent of a timely warning notice or emergency notification is to enable members of the campus community to protect themselves and aid in the prevention of similar crimes. It is critical that pertinent information is provided as soon as it is available.

Instructions

Please provide as much information as possible on the CSA report. The inclusion of personally identifiable information (complainant's name, suspect's name, etc.) is not required, but the inclusion of such information, if known, may assist the University in providing services and reduce the possibility of double-counting incidents.

The University makes many resources available to victims, survivors and witnesses of crime at no cost. If you would like to learn more about these resources, have questions about this form, or would like assistance completing this form, please contact our office by email at publicsafety@bucknell.edu.

Campus Security Authority Contact Information

Incident Details

If you do not know the exact date of the incident, please select this option.
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Please provide specific, detailed information related to the reported incident(s).
Please indicate, if known, the location where the incident occurred. If on campus, please specify the exact location. If off campus in a University-controlled or leased space, please indicate that location.

Incident Category (select all that apply)

Non-negligent or negligent manslaughter (including vehicular manslaughter).
Unlawful attack upon another with intent to inflict severe injury or great bodily harm.
Rape, fondling, statutory rape or incest
Type of sex offense
If rape or fondling, were the victim and the offender acquainted (did they know each other)?
Unlawful entry into a structure to commit a felony or theft.
Taking or attempting to take something by force, violence, threat or by putting the victim in a state of fear.
Theft of automobiles, motorcycles, etc., including "joyriding" (taking by a person without lawful access).
Willful or malicious burning/attempt to burn a structure, vehicle, or personal property of another.
A crime reported to local police agencies or to a CSA that manifests evidence that the victim was intentionally selected because of the perpetrator’s bias against the victim. For the purposes of this section, the categories of bias include the victim’s actual or perceived race, religion, gender, gender identity, sexual orientation, ethnicity, national origin and disability.

For Clery Act purposes, hate crimes include any of the following offenses that are motivated by bias: murder and non-negligent manslaughter, manslaughter by negligence, sex offenses (rape, fondling, incest and statutory rape), robbery, aggravated assault, burglary, motor vehicle theft, arson, larceny-theft, simple assault, intimidation, or destruction/damage/vandalism of property.
Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim.
Domestic violence is violence committed by a current or former spouse; intimate partner of the victim; person with whom the victim shares a child in common; current or former cohabitant who lived as a spouse or intimate partner with the victim; a person who, by law, is similarly situated to a spouse of the victim; or any other person against an adult or child victim who is protected from that person's acts under the domestic or family violence laws in the jurisdiction where the crime of violence occurred.
Engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for their safety or the safety of others, or suffer substantial emotional distress.
Underage possession or consumption, or distribution to minors.
Liquor Arrest or Disciplinary Referral
Possession or distribution of controlled substances or possession of drug paraphernalia.
Drug Use Arrest or Disciplinary Referral
Possession or use of an illegal weapon
Weapon Law Arrest or Disciplinary Referral
Was Bucknell Public Safety notified?

Reporting Party Information

Note: Do not enter if confidently requested.
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