Campus Security Authority (CSA) Reporting Form The CSA Report form is intended to provide CSAs with a method of reporting Clery crimes to Public Safety for inclusion in the College's annual compilation of Clery statistics. The CSA Report is NOT a method of notifying police of an emergency, dangerous situation or other hazard. The submission of the CSA Report will NOT prompt a police investigation or generate an official police report or case number. 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 is provided as soon as it is available. Please provide as much information as possible on the CSA Report. However, 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 College in providing services and eliminating the possibility of double-counting incidents. The College 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 at (413) 775-1212 or by email at publicsafety@gcc.mass.edu. This form is used to gather statistical information to aid the College in compiling required statistics related to crimes that occur on campus and other College owned or controlled property. The collection of this information is required by the Higher Education Act and the Clery Act. This is NOT a report for the purposes of initiating a criminal investigation. However, Public Safety personnel will review this information to evaluate crime trends and to determine whether the circumstances reported require the issuance of a campus-wide warning. CSA Contact InfoPerson completing this formYour Name* First Last Phone*Email* Enter Email Confirm Email Your DepartmentDate Incident OccurredPlease provide the date the crime occurred. If the date is not known, please provide a time frame.Date known?* Yes No Reporting party does not wish to provide this information Approximate time frame*E.g., Spring 2019Date of incident* MM slash DD slash YYYY Date the victim/witness reported this incident to you or that you became aware of the incident.Incident InformationBrief description of incident*Has this incident been reported to another College office?* Yes No I do not know Clery statistics group incidents based on the location where the event occurred. Locations are categorized as follows: on campus; on public property (state roads or sidewalks running through campus), and on non-campus property (property that is owned or controlled by the College but not part of the main campus).Campus and/or Location of Incident*Please chooseMain campus (One College Drive, Greenfield)Downtown Center (270 Main Street, Greenfield)Smith Vocational and Agricultural High School (80 Locust St., Northampton)Franklin County Technical School (82 Industrial Blvd., Turners Falls)Franklin County Sheriff’s Office (160 Elm St., Greenfield, MA)OtherReporting party does not wish to provide this informationSelect the campus where the incident occurred. If the incident occurred off campus or you are unsure of the exact location, please choose the location that is best associated with this incident.Location*Pick the choice that best describes the location where the incident occurred On campus inside a building On campus - street/roadway On campus - on the sidewalk On campus - outside, not in any building Off campus at a non-GCC location Off campus at another GCC location I do not know Other Location description*If you are unsure how to classify the location using the above choices, please provide your best description of the location.Did the incident occur on property owned, controlled, or leased by the College or College-affiliated organization?* Yes No I do not know Other Specify*Did the incident occur at a College-sponsored activity or event?* Yes No I do not know Other Specify*ClassificationPlease choose the best classification based on your knowledge of the incident. Definitions of the listed incidents can be found here.Clery Act Offenses* Murder/Non-Negligent Manslaughter Manslaughter by Negligence Robbery Aggravated Assault Burglary Motor Vehicle Theft Arson Weapon Law Violations Drug Abuse Violations Liquor Law Violations None of the above Sex Offenses* Rape Fondling Incest Statutory Rape None of the above Hate Crimes* Larceny Vandalism Intimidation Simple Assault None of the above 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.What type of bias or hate crime?* Race Religion Sexual Orientation Gender Gender Identity Ethnicity National Origin Disability Other Offenses* Dating Violence Domestic Violence Stalking None of the above Was the victim told that they can report this incident to the police?* Yes No The police are already involved Does the victim wish to have police involvement?* Yes No The police are already involved I do not know Additional Information