Virginia Peninsula Incident Reporting Form

IF THIS IS AN EMERGENCY, MOVE TO A SAFE AREA AND DIAL 9-1-1.
Report an Incident

Please complete the reporting form to the best of your ability, including as many details about the incident as possible.
The information you provide will be submitted to your local Federation Security Director, and the Secure Community Network (SCN) Duty Desk. SCN is the official safety and security organization of the Jewish community in North America.
What type of incident is this?*

In-Person Assault or ThreatSuspicious Person or ActivityProperty Damage or VandalismThreatening or Suspicious Phone Call or TextCyber/Social Media ThreatSuspicious Package or LetterSuspicious/Spam/Phishing EmailFlyeringOther (Explain Below)
Date of Occurrence

MonthDayYear
Date
Describe What Happened*
Where did the incident occur?
Name of the facility or location
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Was law enforcement notified?

YesYes, more than one agency or departmentNo
Please provide the following if available
Please provide the following if available - 2
Please provide the following if available - 3
Please provide the following if available - 4
Please add additional agencies or reports to the "Additional Information" field at the bottom of this form.
Have any other notifications been made?

NoneSecurity DirectorFederation/Organization LeadershipFacility ManagementCommunity MembersNon-Law Enforcement Public AgencyMedia or Social Media PostSCN Alert/Mass Notification BroadcastOther
Please provide details on the notifications selected.
Were weapons either involved or implied?*

YesNo
What type of weapons? Please include type, style, color, and if the weapon was shown or implied.
How many offenders or persons of interest were involved?

UnknownOneTwoThree or More
Please Provide All Available Details About the Subject
Please Provide All Available Details About the Subject 2
Please Provide All Available Details About the Subject 3
Please add additional subjects to the "Additional Information" field at the bottom of this form.
How many online offenders or persons of interest were involved??

UnknownOneTwoThree or More
Please Provide All Available Information on the Subject's Online Persona
Please Provide All Available Information on the Subject's Online Persona 2
Please Provide All Available Information on the Subject's Online Persona 3
Please add additional subjects to the "Additional Information" field at the bottom of this form.
Were any vehicles involved?

YesNoUnknown
Describe the Involved Vehicle
If there are additional vehicles, please describe them under "Additional Information" at the end of this page
Provide any associated web-links or URLs
Copy and Paste the Internet Header from the Email
Upload Images, Screenshots, Video, Documents, and Other Related Files

Cancelof
Impacted Person(s), Witness, or Property Representative Information
Additional Information
Contact Information

Providing your contact information, though not required, allows security professionals to contact you if additional information or clarification is required.
Your Name

First NameLast Name
Your Federation, Organization, and/or Affiliation
Your Position or Title
Your Email
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I Prefer to Remain Anonymous
Contacting the Secure Community Network (SCN) Duty Desk

To follow up on your report, provide new information, or if you are experiencing technical difficulties, please email DutyDesk@securecommunitynetwork.org or call (844) SCN-DESK
Please verify in order to submit.*
Should be Empty:

IF THIS IS AN EMERGENCY, MOVE TO A SAFE AREA AND DIAL 9-1-1.

Report an Incident

Please add additional agencies or reports to the "Additional Information" field at the bottom of this form.

Please add additional subjects to the "Additional Information" field at the bottom of this form.

Please add additional subjects to the "Additional Information" field at the bottom of this form.

If there are additional vehicles, please describe them under "Additional Information" at the end of this page

Contact Information

Contacting the Secure Community Network (SCN) Duty Desk