CSA Report Form

The Campus Security Authority (CSA) Report Form is to be used by Campus Security Authorities (CSAs) or individuals who believe they may be a Campus Security Authority, to report Clery Act crimes. CSAs are responsible for reporting allegations of Clery Act Crimes that are reported to them in their capacity as a CSA. CSAs are not responsible for determining whether a crime took place. Whether or not you know you are a CSA please use this form. If you are unsure if you should be using this form contact the Director of Security at (507) 457-5555. In an emergency, call 911.

In most cases it is possible for a CSA to fulfill his or her responsibility while still maintaining victim confidentiality. You can effectively complete this form without disclosing personally identifiable information about the victim.

This CSA report does not automatically result in the initiation of a police or disciplinary investigation. If the victim would like to pursue disciplinary action direct them to Title IX Coordinator/Dean of Students at (507) 453-1420.

Fill out as much information as possible when using this form. If you do not know the information leave it blank. It is not your duty to investigate the incident, but rather it is your duty to report the incident.

To ensure proper Clery Act classification of the incident being reported, the contact information of the person filling out this form is being requested. Contact will be limited and only initiated if the Director of Security needs further assistance.

If you need assistance in filling out this form please contact the Director of Security at (507) 457-5555.


Campus Security Authorities are federally mandated crime reporters. CSAs shall report, on a timely basis, any Clery Act crimes that they are made aware of to Security by using this form. It is important for CSAs to document sufficient incident details to allow for proper classification of the crime(s).

Involved Parties

Anonymity– If a crime reporting party requests anonymity, this request must be honored to the extent permitted by law. Accordingly, no information should be included on this form that would personally identify the victim without his/her consent.


Reported Crime

Crime Reporting – It is the policy of MSCS to ensure that the victims of crimes are aware of their right to report criminal acts to the Winona Police Department (507-457-6295) or the Red Wing Police Department (651-385-3155). CSAs should ask the reporting party if they would like to report the crime to Winona Police or Red Wing Police. If the reporting party would like law enforcement contacted the CSA should assist the victim in the request.

Sexual Incidents CSAs reporting a student or employee reported incidence of sexual violence are encouraged to provide campus/community resources as well as direct them to the MSC Southeast Reporting Sexual Violence web page or contact the 24/7 GBV Helpline at (507) 452-4453 for the Winona Campus and (800) 369-5214 for the Red Wing Campus.

  Criminal Homicide: Murder and Non-Negligent Manslaughter
  Manslaughter by Negligence
  Sexual Assault
  Statutory Rape
  Aggravated Assault
  Motor Vehicle Theft
  Dating Violence
  Domestic Violence
  Drug/Narcotic Violations
  Alcohol Violations
  Weapon Violations

Hate Crimes - The following crimes also need to be reported, for Clery Act purposes, if the victim(s) of the reported crime was/were targeted specifically because of bias/prejudice against the victim based on race, religion, gender, gender identity, ethnicity, national origin, or disability. As needed, click Clery Crimes for definitions.(Required)

  Simple Assault
  Destruction/Damage/Vandalism of Property

If a liquor, drug, or weapon law violation is reported, the corresponding number or persons referred must be entered. Please select the applicable violation below if it pertains to your report. As needed, click Clery Crimes for alcohol, drug and weapons violation definitions.

  Liquor Law Violation
  Drug Law Violation
  Weapon Law Violation

Are you aware if this incident was already reported to a Law Enforcement agency, MSCS Official or if the reporting party was planning to make a report with Law Enforcement or a MSCS Official? If so, please list the individual or agency the report was or is being made to. If not, leave blank.

Please provide a description of the reported crime (what happened?) to help with the Clery Act crime classification.

Supporting Documentation

Photos, video, text files, and other supporting documents may be attached below. 500MB maximum total size.
Accepted extensions
.pdf, .jpg, .jpeg, .gif, .png, .bmp, .mov, .mp4, .mp3, .avi, .txt, .doc, .docx, .eml, .msg
Attachments require time to upload, so please be patient after submitting this form.
NOTE: file extensions must be lower-case (e.g. .jpg, not .JPG).

Hold "Ctl" (or Command Key) to select multiple files.

Submitting the Information.