OFFENSE/INCIDENT REPORT
RCS: DAEN-PM7
(ER 190-1-50)
REPORT NO.
MPI/CID NO.
DATE OF REPORT
TO:
FROM:
1. OFFENSE/INCIDENT
CORPS EMPLOYEE INVOLVED:
YES
NO
PERSON
IF YES, NUMBER INVOLVED
PROPERTY
TITLE
FRAUD
SEX OFFENSE
CODE
AS VICTIM
SUBJECT
2. LOCATION (Include county, state or territory in which person,
TIME
installation facility or recreation area involved is located.)
DATE
DATE (Occurred overnight or weekend)
3. REPORTED BY:
ADDRESS
4. TYPE/STATUS OF REPORT
CLOSED
INITIAL
FOLLOW-UP
ADD-ON
CMOIR
5. DETAILS (who, what, when, where, why, how), SUPPORTING PHOTOGRAPHS, NEWSPAPER ARTICLES, ETC., MAY BE ATTACHED
DO NOT ATTACH REPORTS FROM OTHER AGENCIES. IF ADDITIONAL SPACE IS REQUIRED, USE SEPARATE SHEET.
6.
REPORTED
REFERRED TO
LOCAL POLICE
SHERIFF
7. RECOMMENDED PREVENTIVE CORRECTIVE ACTION, IF APPROPRIATE
8. DOLLAR VALUE
a. GOVERNMENT PROPERTY
$
b. CONTRACTOR PROPERTY $
INVOLVED
9. OCCURRED ON/AGAINST
CORPS PERSONNEL, EQUIPMENT OR PROPERTY
VANDALISM TO CORPS PROPERTY
OTHER THAN RECREATION AREAS
LARCENY OF CORPS PROPERTY
RECREATION AREAS
PRIVATE PERSONNEL OR PROPERTY
NAME, GRADE AND TITLE OF REPORTING OFFICER
SIGNATURE
ENG FORM 4337, Jun 80
(Proponent: CEPM)
EDITION OF 1 MARCH 1978 IS OBSOLETE.