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Campus Security Authority (CSA) Crime Report Form

Note: Please complete all relevant fields. Required fields are indicted with red asterisks (*). 

CSAs are required to report alleged Clery Crimes that occur within Clery Geography. For more information on these offenses and their definitions, see the Clery Crimes and Geography page. Keep in mind that campus affiliation of the suspect or victim is not required; only the crime type and geography is relevant to Clery Act reporting.  

Do not use this form to report incidents that present an immediate or ongoing threat to health or safety, as submissions using this form are entered into an inbox that is not actively monitored 24/7/365. Additionally, submitting a report using this form does not initiate a law enforcement response. If a crime reported to you could be a threat to health or safety, it should be reported immediately to the UCLA Police Department for a potential campus-wide notification. If you would like to submit a report to law enforcement, please call 9-1-1 (emergency) or the UCLA Police Department non-emergency line at (310) 825-1491. 

If you have any questions or would like assistance completing this form, please contact the UCLA Clery Compliance Team at clery@compliance.ucla.edu. 

CSA Crime Report Form

CSA Contact Information
Incident Date
Please include the date(s) the incident occurred or type "unknown" if unsure.
Incident Location(s)
What best describes the location of the crime? If the crime occurred in multiple places, check all that apply:
Clery Crime Classification
Please check all that apply:
Hate Crime Types
If this incident involved a Hate Crime, select the bias motivation (check all that apply):
Arrests or Disciplinary Referrals (check all that apply):
Description of the Incident
Law Enforcement Notification
Was this incident reported to law enforcement?
UCLA Department Notification
Has the incident been reported to another UCLA Department?
Submission Instructions
Once completed, you may submit this form electronically by clicking on the Submit button below.
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