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UW-Eau Claire Incident/Crime Report


This form is to be filled out when an incident or crime report is received, pursuant to Title IX, WI § 36.11(22)(c), and/or the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act).The purpose of this form is to collect crime and referral statistics and to inform UW-Eau Claire of crimes so that UW-Eau Claire can follow-up with action when appropriate. Information gathered may also result in an investigation by the Dean of Students Office or the Affirmative Action Office. Statistical information gathered may be reported in UW-Eau Claire's Annual Security and Fire Safety Report.

Reminder: You DO NOT need to know all the answers to the questions below. You are NOT expected to investigate further or ask people involved specific questions in order to fill out this form completely.

Note: Information gathered from these forms will not result in a police investigation. If you want to report a crime to law enforcement, please call University Police at 911 (emergency) or 715-839-4972 any time, or come to their office in the Crest Wellness Center between 8:00 AM and 4:00 PM.

For information regarding the Clery Act's Campus Security Authority reporting responsibilities, click here.

For information regarding Wisconsin's sexual assault reporting responsibilities for employees (WI § 36.11(22)(c)), click here.

For rights and resources for people reporting sexual assault, domestic violence, dating violence and stalking, click here

For questions, call the Dean of Students Office at 715-836-5626.

If you have chosen the wrong form, you may use these links to connect to the correct form:
Bias Incident Report Form - click here.
Student of Concern Report - click here.
Hazing Report Form - click here.
Academic Misconduct Report - click here.

Background Information

 
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Email address must be of a valid format.
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Definitions: http://docs.legis.wi.gov/statutes/statutes/940/II/225
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Please list the date the incident occurred below.
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(Please note city/country for any reports outside of Eau Claire in box marked “Specific Location”);

Victim and Alleged Assailant Information

If you are a Campus Security Authority, please provide victim and alleged assailant's name if they were reported to you. Names are not required if you are excluded from Campus Security Authority responsibilities. This information will be treated with care and limited access.

Involved party 1

Required Information

Were alcohol or other drugs involved? (Check all that apply.)(Required)
You must make at least one selection.
Has the victim been referred to the following agencies? (Check all that apply.)(Required)
You must make at least one selection.
Has the victim had contact with police agencies? (Check all that apply.)?(Required)
You must make at least one selection.
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What was the university connection when the assault occurred?(Required)
You must make at least one selection.
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Please include any documents or photos you wish to report.

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission