Campus Security Authority (CSA) Reporting Form

A Campus Security Authority (CSA) is someone who has been recognized by the Clery Act as a federally mandated reporter of any Clery Act crimes occurring on campus and campus owned or controlled property. The CSA Reporting form is intended to provide CSA’s with a method of reporting Clery crimes to University Security for inclusion in the University’s Annual Security and Fire Safety Report. However, anyone who is a victim of, or witness to, a crime may also utilize this form to report the crime to appropriate campus authorities.

The CSA Report is NOT a method of notifying University Security or Police of an emergency situation. If this is an emergency, call University Security at 507-389-2111 or Police 9-1-1.

 

Public Safety personnel evaluate 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 be provided as soon as it is available.

CSA’s are encouraged, but not required, to complete this form with the reporting party present. This is beneficial for a number of reasons. First, it helps to ensure that the appropriate information is collected and second, it allows the reporting party to see what information will be submitted.

Please provide as much information as possible on the CSA reporting form. Some information may not be required, but the inclusion of such information, if known, may assist the University in providing resources, services, and accurate annual statistics.

CSA Contact Information

Person completing the form

CSA Contact Information

Person completing the form

Name of Reporting Party

Please provide the name of the victim, survivor, or witness who reported the incident to you.

Name of Reporting Party

Please provide the name of the victim, survivor, or witness who reported the incident to you.

Date and Time Incident Occurred

Please provide the date and time the crime occurred. If the date and/or time are unknown, provide a time frame.

Date and Time Incident Occurred

Please provide the date and time the crime occurred. If the date and/or time are unknown, provide a time frame.

Location of the Incident

Please provide the location of the incident. Be as specific as possible (street address, building name, office or room number, etc.). This will help properly classify this incident.

Location of the Incident

Please provide the location of the incident. Be as specific as possible (street address, building name, office or room number, etc.). This will help properly classify this incident.

Location Classification

If the crime occurred in multiple places, check all that apply.

Please see the Geography and Location Definitions chart for further explanation as to the geography.

Location Classification

If the crime occurred in multiple places, check all that apply.

Please see the Geography and Location Definitions chart for further explanation as to the geography.

Did the incident occur at a University-Sponsored Event?

Incident Information

Please provide a brief description of the incident. Provide any information that was reported to you about what occurred.

Incident Information

Please provide a brief description of the incident. Provide any information that was reported to you about what occurred.

Type of Crime

Please choose the best classification for the type of crime based on your knowledge of the incident.

Please see the Crime Definitions chart for further explanation of the listed incidents.

Type of Crime

Please choose the best classification for the type of crime based on your knowledge of the incident.

Please see the Crime Definitions chart for further explanation of the listed incidents.

A hate crime is any of the above listed crimes that include some evidence that the offender was motivated by bias or hate toward a particular class of person or people. The type of bias should be indicated below.

A hate crime is any of the above listed crimes that include some evidence that the offender was motivated by bias or hate toward a particular class of person or people. The type of bias should be indicated below.

Type of bias or hate crime

Other University Involvement

Please indicate if the incident has been reported to another University Office, check all that apply.

Other University Involvement

Please indicate if the incident has been reported to another University Office, check all that apply.

To your knowledge, was the incident reported to another University Office

Law Enforcement Involvement

Please indicate if the incident has been reported to law enforcement.

Law Enforcement Involvement

Please indicate if the incident has been reported to law enforcement.

Does the victim wish to have police or law enforcement involvement?

Further Action

Please indicate what action the reporting party would like to pursue. This information helps determine if follow up action from the University is needed. If “No Action” is indicated, the reporting party will not be contacted.

Further Action

Please indicate what action the reporting party would like to pursue. This information helps determine if follow up action from the University is needed. If “No Action” is indicated, the reporting party will not be contacted.

What action would the reporting party wish to pursue?

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