Incident Report Form CA

Your Name

Your Email Address

Location

Date of Incident

Time of Incident

Emergency Category

Was Law Enforcement Called?

Describe incident, location, etc

Name/Description of Offender

Name/Description of Victim

List Witnesses/ Contact Info (if available)

Describe action taken by staff

Other Remarks

Images/Documents

Upload

One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, gif, jpg, png.

Images/Documents 2

Upload

One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, gif, jpg, png.

Security Contact

Barkman

719-582-7292

Lamb

719-582-7331

Lucero

719-582-7259

Pueblo West

719-582-7261

Rawlings

x621 or 719-252-8500

Security Supervisor

719-470-8062

Rawlings Director

719-248-3196

Facilities Emergency Number: 719-250-0425

Custodial Emergency Number: 719-240-0033

If there is no answer call the Facilities Director at 719-717-0822

For all other facilities needs please have a manager submit a facilities work order.