Attachment 3(B) - CSO Form 003.pdf

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Form CSO-003 Rev. 09/12 U.S. Department of Justice United States Marshals Service Court Facility Incident Report INSTRUCTIONS: Use Form CSO-003 to report disruptive incidents in the courthouse. See last page for detailed instructions. Submit completed report to the District Judicial Security Inspector for notification.

7. WAS SUBJECT DETAINED?

10. TYPE OF INCIDENT (Check applicable box):

(alarms, elevators, garage doors, security lighting, etc.)

11. CHECK APPLICABLE BOX:

13. REPORT PAGES:

ATTACHED PAGES

I hereby certify that the information stated herein is true, complete, and accurate to the best of my knowledge.

18. DISTRIBUTION: DISTRICT COTR - 1 COPY / OCS - 1 COPY

Court Facility Incident Report (continued)

3. PAGE ____ OF ____

Court Facility Incident Report Instructions

BLOCK NUMBER

REPORT REQUIREMENT

1. DATE OF REPORT

State the date that the report is being prepared.

2. DATE OF INCIDENT

Self-explanatory.

3. TIME OF INCIDENT

Indicate the approximate time that the incident occurred.

4. GSA BUILDING NO.

Self-explanatory.

5. BUILDING NAME

Self-explanatory.

6. BUILDING ADDRESS

Self-explanatory.

7. WAS SUBJECT DETAINED?

Check 'YES' if any subject has been detained for any length of time.

8. REPORTING DISTRICT

Indicate the name of the district preparing the report. Please annotate if different than where the incident occurred.

9. REPORTED BY

Provide the name of the person preparing the report.

10. TYPE OF INCIDENT

Check the applicable box that best describes the type of incident. If "Other" is checked, give a one or two word description that best describes the incident.

11. CHECK APPLICABLE BOX

Indicate whether this is an initial report, a follow-up, or an addendum to a previous report.

12. INCIDENT DESCRIPTION

At a minimum, the report must address the following:

WHO: Provide the name(s) of the person(s) involved and their date of birth.

WHAT: Describe what happened in detail.

WHERE: Where did the incident happen? City, building, floor, room, etc.

WHEN: Date and time of the incident.

HOW: If not already covered in the "WHAT" category, describe how the incident happened.

All reports must be legible, complete, and accurate as possible. Explain the incident in detail, from the beginning to the end. Never end in the middle of the story.

BE SURE THAT THE REPORT CAN BE READ BY SOMEONE OTHER THAN YOU.

13. REPORT PAGES

If the narrative describing the incident is included on additional pages, write the number of pages attached. If the contents of the report are sensitive in nature, each page should be marked "FOR OFFICIAL USE ONLY".

14. SIGNATURE OF PREPARER

Self-explanatory.

14a. DATE Enter the date you signed this report.

15. APPROVED BY

Indicate the name of the contractor's reviewing and approving official.

15a. TITLE Indicate the title of the contractor's reviewing and approving official. (NOTE: Must be a supervisory representative.)

15b. DATE Enter the date the report was reviewed, approved and signed by the contractor's supervisory representative.

16. DISTRIBUTION

Immediately forward a copy of this report as indicated.

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