Incident Report Form Regular

Your Name

Your Email Address

Location

Date of Incident

Time of Incident

Primary Emergency Category (Choose 1)

Additional Offenses/Emergencies (choose up to 4)

Was Law Enforcement Involved?

If law enforcement was involved, please list the officer's name and badge number:

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

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

Additional Images/Documents 2

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

Video File

One file only.
100 MB limit.
Allowed types: avi, mov, mp4, ogg, wav, webm.

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.