Vandalism Report

Complete One Form Per Incident
If no incidents occurred, please type a 0 in the "Incident Number for the Month" box and N/A in the "Description" box below.

School / Department Name?

Month / Year of Report?

Person Completing This Report:

Incident Number for the Month
Date of Occurrence
Description: Describe in the box below what occurred and any damage to building or property, etc.

NOTE: You will need to fax (or scan to a file and attach to an email) any supporting documentation, if any,for the incident(s) above.

Was damage to building / property reported on (blue) Operations and Maintenance Form MA / 77? Yes No
Was appropriate law enforcement agencey called? Yes No
Is report being sent via courier? Yes No
Did District Security Officer (DSO) investigate? Name: Yes No
Is the DSO's report attached? Yes No

ITEM(S) STOLEN / DAMAGED
Current
Value
Original
Purchase
Price
Date
of
Purchase

Comments (list any comments pertinent to this vandalism report; problems, incomplete reports, etc., if any):

Your Email Address:

Once you submit your form, you will see a verification of information page. Please print that page for your records. (If you notice you have made an error in your form entry at the verification page, please click your back button and re-complete and re-submit this form. Please place a note in the special notes box to let the recipient know that you have made an earlier error and are sending the corrected one.)