Attachment 3(B) - CSO Form 003.pdf

ADDENDUM

(initial report dated: )

REPORT CONTINUED ON ATTACHED PAGE(S).

11. CHECK APPLICABLE BOX

FOLLOW-UP REPORTINITIAL REPORT

12. INCIDENT DESCRIPTION (Details should cover who, what, where, when and how.)

13. REPORT PAGES

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

14. SIGNATURE OF PREPARER 15. DATE 18. DISTRIBUTION

DISTRICT COTR - 1 COPY

OCS - 1 COPY16. APPROVED BY: 17. DATE

NAME

TITLE

PAGE 1 OF 3 Form CSO-003 (Rev. 05/09)

Section J - Attachment 3(B)

10. TYPE OF INCIDENT (Check Applicable Box)

Alarm Activation Assault Bomb Threat Contraband Disruptive Person Forced Entry Illegal Weapon Malfunctioning Equipment (alarms, elevators, garage doors, security lighting, etc.)

Medical Emergency Missing Property Open/Unsecured doors Property Damage Security Breaches Shooting Suspicious Individuals on Perimeter Suspicious/Unattended Package

Suspicious Vehicles (Perimeter Areas) Unauthorized Persons Vehicle Break-Ins/Burglaries Other (Describe:)

COURT FACILITY INCIDENT REPORT

1. DATE OF REPORT 2. DATE OF INCIDENT 3. TIME OF INCIDENT

7. ARREST/DETENTION 8. REPORTING DISTRICT 9. REPORTED BY

YES NO

4. GSA BUILDING NO. 5. BUILDING NAME 6. BUILDING ADDRESS

COURT FACILITY INCIDENT REPORT

(Continuation Sheet)

OF

1. DATE OF REPORT 2. DATE OF INCIDENT 3. PAGE(s)

INCIDENT DESCRIPTION (Details should cover who, what, where, when and how.)

PAGE 2 OF 3 Form CSO-003 (Rev. 05/09)

Section J - Attachment 3(B)

BLOCK NUMBER REPORT REQUIREMENT

1. DATE OF REPORT

2. DATE OF INCIDENT

9. REPORTED BY

7. ARREST/DETENTION

8. REPORTING DISTRICT

10. TYPE OF INCIDENT

11. CHECK APPLICABLE BOX

12. INCIDENT DESCRIPTION

13. REPORT PAGES

14. SIGNATURE OF PREPARER

15. DATE

16. APPROVED BY

17. DATE

18. DISTRIBUTION

3. TIME OF INCIDENT

4. GSA BUILDING NO.

5. BUILDING NAME

6. BUILDING ADDRESS

COURT FACILITY INCIDENT REPORT

State the date the report is being prepared.

Self explanatory.

Provide the name of person preparing the report.

Check the box at the bottom of this section if anyone is detained for any length of time or arrested.

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

Indicate the approximate time that the incident occurred.

Check 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.

At a minimum, the report must address the following:

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

OFFICIAL USE ONLY.''

Self explanatory.

Enter the date you signed this report.

NOTE: The reviewing and approving official must be a supervisory representative.

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

Immediately forward a copy of this report as indicated.

PAGE 3 OF 3 Form CSO-003 (Rev. 05/09)

Section J - Attachment 3(B)

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

Indicate the name and title of the Contractor's official reviewing and approving official.

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.

Self explanatory.

Self explanatory.

Self explanatory.