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Campus Security Authority (CSA) Reporting Form

  1. Gather as much requested data as possible based on information volunteered or discussed.
  2. Refer to the Definitions of Crimes for Use in Campus Security Report for classifying the type of criminal offense reported.
  3. The “Victim referred from” category is included in order to prevent duplicate reporting of offenses.
  4. Gather this data even if the victim indicates that she or he has spoken with another university official regarding this incident and even if you will be referring the victim to another department.
  5. Submit this form below. It will be forwarded to the UF Health Jacksonville Clery Compliance Coordinator.
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Refer to Definitions of Crimes for Use in Campus Security Report, below.

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Definitions of Crimes for Use in Campus Security Report

Murder - The willful (non-negligent) killing of one human being by another.

Manslaughter - The killing of another person through negligence.

Rape - The carnal knowledge of a person, forcibly and/or against the person’s will; or not forcibly or against the person’s will where the victim is incapable of giving consent because of his/her temporary permanent mental or physical incapacity (or because of his/her youth).

Forcible Fondling - The touching of the private body parts of another person for the purpose of sexual gratification, forcibly and/or against the person’s will; or not forcibly or against the person’s will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary permanent mental or physical incapacity.

Incest - Non-forcible sexual intercourse between persons who are related to each other within the degrees wherein marriage is prohibited by law. Statutory Rape - Non-forcible sexual intercourse with a person who is under the statutory age of consent.

Robbery - The taking, or attempting to take, anything of value under confrontational circumstances from the control, custody or care of another person by force or threat of force or violence and/or by putting the victim in fear.

Aggravated Assault - An unlawful attack by one person upon another where either the offender displays a weapon, or the victim suffers obvious severe or aggravated bodily injury involving apparent broken bones, loss of teeth, possible internal injury, severe laceration or loss of consciousness.

Burglary - The unlawful entry into a building or other structure with the intent to commit a felony or a theft.

Motor Vehicle Theft - The theft or attempted theft of a motor vehicle.

Arson - To unlawfully and intentionally damage, or attempt to damage, any real or personal property by fire or incendiary device.

Liquor Law Violations - The violation of laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possessing or use of intoxicating alcoholic beverages.

Drug Related Violations  (Sale and Possession) - The unlawful cultivation, manufacture, distribution, sale, purchase, possession, transportation or importation of any controlled drug or narcotic substance.  Or, the unlawful manufacture, sale, purchase, possession or transportation of equipment or devices used for preparing and/or taking drugs or narcotics (drug paraphernalia).

Weapon Law Violations - The violation of laws or ordinances prohibiting the manufacture, sale, purchase, transportation, possession or use of firearms, cutting instruments, explosives, incendiary devices or other deadly weapons.

Hate Crime Reporting – All hate crimes associated with any of the following crimes: homicide, sex offenses, robbery, aggravated assault, burglary, motor vehicle theft, arson, any other crime involving bodily injury, larceny-theft, simple assault, intimidation and destruction/damage/vandalism of property reported to law enforcement need to be reported.  Hate crimes are those crimes that manifest evidence that the victim was intentionally selected because of the perpetrator’s bias toward race, gender, religion, sexual orientation, national origin, gender identity, ethnicity, or disability of the victim. If a hate crime is reported, the type of prejudice and the type of crime need to be listed.

Domestic Violence - The term ‘‘domestic violence’’ includes felony or misdemeanor crimes of violence committed by a current or former spouse of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction receiving grant monies, or by any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdiction.

Dating Violence- The term ‘‘dating violence’’ means violence committed by a person— (A) who is or has been in a social relationship of a romantic or intimate nature with the victim; and (B) where the existence of such a relationship shall be determined based on a consideration of the following factors: (i) The length of the relationship. (ii) The type of relationship. (iii) The frequency of interaction between the persons involved in the relationship.

Stalking - The term ‘‘stalking’’ means engaging in a course of conduct directed at a specific person that would cause a reasonable person to— (A) fear for his or her safety or the safety of others; or (B) suffer substantial emotional distress.