Skip to main content

CSA Incident Report Form

Overview and Failure to Report:

Those individuals who meet the definition of a "Campus Security Authority" (CSA) at LMU Loyola Law School shall complete this form pursuant to the Jeanne Clery Disclosure of Campus Security Police and Campus Crime Statistics Act, (Clery Act) codified at 20 USC 1092 (f) as part of the Higher Education Act of 1965.

Note: Failure to report as required my result in a violation of this said requirement subjecting the University to penalties (including a $35,000 fine per violation).

Complete this form for the required reportable incidents:

Confidentiality Notice: LMU Loyola Law School encourages students, faculty, staff, and visitors to report crime/incidents to the Department of Safety and Security or the appropriate office for institutional policy violations.  Campus Security Authorities (CSA's), however, must honor any requests for confidentiality made by a reporting person pursuant to Federal law.  As a result, no information should be included in this report which would disclose the identity of the reporting person without their consent.

Campus Security Authority Contact Information
Incident Date & Time Information
Incident Location Information
Please include building/business name; office/room number; intersection/cross streets; street name(s); city/state; and any other specific details.
Location Clasification
All campus buildings, parking lot
All leased building space or land
All property immediately accessible and adjacent to campus, public roadways, parks, etc.
Check only one.
Incident Classification
Incident Classification

Please indicate if this was a "Bias or Hate Crime" Incident resulting in any violation from the question above or a violation of the following classifications:

Bias or Hate Crime Additional Classification
Please specify the additional Incident Classification Violation above.
Bias or Hate Crime Classification
Please provide a narrative description and as many details as possible as it relates to the reported Incident Classification.
Alcohol Referrals to Student Affairs or Human Resources

Certain Law Violations reported to the above entities must be reported.  These only include Law Violations not Policy Violations.

Law Violation Classification
Any violation of liquor laws - does NOT include operating a vehicle under the influence.
Any violation of drug laws.
Any violation of weapons laws.
Law Enforcement Agency Notification and Reporting
Please list any law enforcement agency(s) the incident was reported to.

Campus Security Authorities (CSA's) are encouraged to report incidents in a timely manner. 

Reminder:  Requests of confidentiality made by a reporting person must be honored pursuant to Federal law.  Please review the information you have included in this form to make sure that you have received consent from the reporting person(s) to share.

Once you have completed your review, click Submit to have the form sent to Joe Archie and Al Taylor.  You will also receive a copy of your submission.