Incident Report Form

Notice: Online reports are not official reports.  Only the printed copy, signed by the reporting officer and containing a Department or Eugene Police issued case number are considered the official copy.  This online report form is intended to facilitate the report process by providing officers pertinent information about the incident in a timely manner so that an official report can be prepared and submitted through the reporting system.

Instructions

If you are a victim or witness of a non-urgent crime; such as, theft of property, fraud, or drugs, please fill out this form as completely as possible.

Before an official report can be filed, a DPS officer must be able to contact you to verify all the information you provided.  They may also have additional question regarding the incident.

Include your full name, address, and contact information.

If you are unsure of any details requested on this form, leave those fields blank.  Providing misleading or inaccurate information may slow the report filing process.

Please allow 24 hours for an officer to contact you for verification.

Personal Information

Name:
(Last, First MI)
Date of Birth:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Preferred Time to Receive Call:
Email Address:

Incident Information

Location:
Date Occurred:
Time Occurred:
Description:
Do you have possible subject information?

yes  no

Object Information

Item:
Serial Number:
Brand:
Inscription:
Model:  
Size:
Color:

Approximate Value:  

By submitting this report, you certify the information you have provided is true and correct to the best of your knowledge.

   

 

   
Criminal Activity Report


Department of Public Safety

1319 East 15th Avenue
Eugene, OR  97403
Ph: 541.346.5444  Fax: 541.346.0947

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