Examples

1110-0057_Cog Test Examples 6-18-14.xlsx

Uniform Crime Reporting Data Collection Instrument Pretesting and Burden Estimation General Clearance

Examples

OMB: 1110-0057

Document [xlsx]
Download: xlsx | pdf

Overview

Incident 1
Incident 2
Incident 3
Incident 4
Incident 5


Sheet 1: Incident 1

Incident-Based Event Report

CLASSIFICATION OF EVENT
1. TYPE OF
REPORT
Offense
2. EVENT START
DATE/TIME
2-22-2013 0200
EVENT END
DATE/TIME
-
3. DATE OF
REPORT
2-22-2012
4. TIME OF
REPORT
0230
5.
DISTRICT
2D
6.
SECTOR
7.
PSA
206
8. COMPLAINT
NO.
13000225
9. EVENT LOCATION
ADDRESS
2 Myrna Blvd.
POSITION
Inside of
CORNER/
BLOCK OF
N
10. REPORT
RECEIVED BY
Radio run
11. RADIO RUN AND EVENT
LOCATION SAME?
N
12. PROPERTY
TYPE
Public
13. EVENT NO. 1 14. EVENT NO. 2 15. EVENT NO. 3
16. FORCED ENTRY
N
17. POINT OF ENTRY
N/A
18a. METHOD USED
Other
18b. TOOLS USED
Blunt Object
19. WEATHER
CONDITIONS
Clear
20. HATE CRIME? 21. SECURITY SYSTEM
Not Applicable
22. LOCATION TYPE
23. DESIGNATED AREA 1 24. DESIGNATED
AREA 2
GANG
RELATED?
N
INTRA-
FAMILY?
N
ABC
ESTABLISHMENT?
N
GROUP
HOME?
N
PD378
ISSUED?
N
CPO TPO
OUTSTANDING?
N/A
SUSPICIOUS?
N
OFFENDER
COUNT #


VICTIM ( ) COMPLAINANT (None Specified)/ REPORTING PERSON (None Specified)
1. Victim Name
Juan Cruz
David Cruz
Related to Event(s)
1
Language Assistance
Needed?
N
Language Assistance
Needed for:
(None Specified)
Date of
Birth
3-4-92
1-18-95
Sex
Male
Male
Home Address
Residency
DC Resident
Home Phone
Other Phone
Race
White
White
Ethnicity
White
White
Occupation
Work Related
N
Business/School Address
Work
Phone
Additional Contact Reporting
Person
Y
Received Referral
Form
Y
Injury Code Describe Injury
Unconscious
Blunt force trauma
Where Taken By Whom? Amb # Injury Status


BUSINESS/AGENCY (None Specified)

MISSING PERSONS (None Specified)


SUSPECTS ( )







1. RACE
Black
Black
SEX
Male
Male
Ethnicity
Black
Black
Related to
Events
1
Age Range
Unknown
HEIGHT
5'9-5'10
6'0-6'2
WEIGHT
210-230
240-250
EYES
Unknown
HAIR
Unknown
COMPLEXION
Dark
Dark
BUILD
Husky
Slender
SCARS FACIAL HAIR
Unknown
HAT COAT/
JACKET
PANTS
SHIRT
SUSPECTED
OF USING


WEAPONS ( )
WEAPON
Blunt Objects

FIREARM
N
COLOR
N/A
MAKE
N/A
MODEL
N/A
CALIBER
N/A

PROPERTY (None Specified)

VEHICLES (None Specified)

Narrative
(Event and Action Taken)
Early in the morning, two Latino immigrant brothers were attacked by two African-American men while walking down the street. The brothers were huddled together to stay warm. The attackers mistakenly believed that the two men were a gay couple because they were walking so closely together. Witnesses told the officers the attackers beat the brothers with a baseball bat and an empty bottle while using anti-gay and anti-Latino slurs.

Sheet 2: Incident 2

Incident-Based Event Report

CLASSIFICATION OF EVENT
1. TYPE OF
REPORT
Offense
2. EVENT START
DATE/TIME
12-16-2013 0200
EVENT END
DATE/TIME
-
3. DATE OF
REPORT
12-16-2013
4. TIME OF
REPORT
0400
5.
DISTRICT
2D
6.
SECTOR
7.
PSA
206
8. COMPLAINT
NO.
13002289
9. EVENT LOCATION
ADDRESS
14 University Ave.
POSITION
Inside of
CORNER/
BLOCK OF
N
10. REPORT
RECEIVED BY
Radio run
11. RADIO RUN AND EVENT
LOCATION SAME?
N
12. PROPERTY
TYPE
Public
13. EVENT NO. 1 14. EVENT NO. 2 15. EVENT NO. 3
16. FORCED ENTRY
N
17. POINT OF ENTRY
N/A
18a. METHOD USED
Other
18b. TOOLS USED
Handgun
19. WEATHER
CONDITIONS
Clear
20. HATE CRIME? 21. SECURITY SYSTEM
Not Applicable
22. LOCATION TYPE
23. DESIGNATED AREA 1 24. DESIGNATED
AREA 2
GANG
RELATED?
N
INTRA-
FAMILY?
N
ABC
ESTABLISHMENT?
N
GROUP
HOME?
N
PD378
ISSUED?
N
CPO TPO
OUTSTANDING?
N/A
SUSPICIOUS?
N
OFFENDER
COUNT #


VICTIM ( ) COMPLAINANT (None Specified)/ REPORTING PERSON (None Specified)
1. Victim Name
Samara Hakim
Yasmin Hakim
Related to Event(s)
1
Language Assistance
Needed?
N
Language Assistance
Needed for:
(None Specified)
Date of
Birth
7-28-98
10-18-71
Sex
Female
Female
Home Address
Residency
Home Phone
Other Phone
Race
White
White
Ethnicity
White
White
Occupation
Work Related
N
Business/School Address
Work
Phone
Additional Contact Reporting
Person
Y
Received Referral
Form
Y
Injury Code Describe Injury
Gunshot
Blunt force trauma
Where Taken By Whom? Amb # Injury Status


BUSINESS/AGENCY (None Specified)

MISSING PERSONS (None Specified)


SUSPECTS ( )







1. RACE
White
SEX
Male
Ethnicity
White
Related to
Events
1
Age Range
50-55
HEIGHT
5'9-5'10
WEIGHT
130-150
EYES
Unknown
HAIR
Brown, Other
COMPLEXION
Light
BUILD
Thin or Slender
SCARS FACIAL HAIR
Unknown
HAT COAT/
JACKET
PANTS
Blue
SHIRT
Blue
SUSPECTED
OF USING


WEAPONS ( )
WEAPON
Handgun
FIREARM
Y
COLOR
Unknown
MAKE
Unknown
MODEL
Unknown
CALIBER
Unknown

PROPERTY (None Specified)

VEHICLES (None Specified)

Narrative
(Event and Action Taken)
An Egyptian American teenager and her mother are overheard in a department store speaking Arabic by a man standing nearby. Later,
they find him following them in a parking lot, where the man proceeds to open his jacket to reveal a gun hanging from his belt. The
man proceeds to walk toward the women and beats the mother with a gun putting a gash in her head, while stating, "You should
learn to speak English."

Sheet 3: Incident 3

Incident-Based Event Report

CLASSIFICATION OF EVENT
1. TYPE OF
REPORT
Offense
2. EVENT START
DATE/TIME
2-17-2013 1600
EVENT END
DATE/TIME
-
3. DATE OF
REPORT
2-17-2013
4. TIME OF
REPORT
1730
5.
DISTRICT
2D
6.
SECTOR
7.
PSA
206
8. COMPLAINT
NO.
13008896
9. EVENT LOCATION
ADDRESS
220 Junior Ave NW
POSITION
Inside of
CORNER/
BLOCK OF
N
10. REPORT
RECEIVED BY
Radio run
11. RADIO RUN AND EVENT
LOCATION SAME?
N
12. PROPERTY
TYPE
Public
13. EVENT NO. 1 14. EVENT NO. 2 15. EVENT NO. 3
16. FORCED ENTRY
N
17. POINT OF ENTRY
N/A
18a. METHOD USED
Other
18b. TOOLS USED
Handgun
19. WEATHER
CONDITIONS
Clear
20. HATE CRIME? 21. SECURITY SYSTEM
Not Applicable
22. LOCATION TYPE
23. DESIGNATED AREA 1 24. DESIGNATED
AREA 2
GANG
RELATED?
N
INTRA-
FAMILY?
N
ABC
ESTABLISHMENT?
N
GROUP
HOME?
N
PD378
ISSUED?
N
CPO TPO
OUTSTANDING?
N/A
SUSPICIOUS?
N
OFFENDER
COUNT #


VICTIM ( ) COMPLAINANT (None Specified)/ REPORTING PERSON (None Specified)
1. Victim Name
Arav Vaidyar
Related to Event(s)
1
Language Assistance
Needed?
N
Language Assistance
Needed for:
(None Specified)
Date of
Birth
4-4-60
Sex
Male
Home Address
24 Western St.
Residency
Home Phone
(304) 599-8592
Other Phone
Race
A - Asian
Ethnicity
A - Asian
Occupation
Work Related
N
Business/School Address
Work
Phone
Additional Contact Reporting
Person
Y
Received Referral
Form
Y
Injury Code Describe Injury
Gunshot
Blunt force trauma
Where Taken By Whom? Amb # Injury Status


BUSINESS/AGENCY (None Specified)

MISSING PERSONS (None Specified)


SUSPECTS ( )







1. RACE
White
Black
SEX
Male
Male
Ethnicity
W - White
B - Black
Related to
Events
1
Age Range
30-35
25-29
HEIGHT
5'9-5'10
5'10-6'0
WEIGHT
150-170
200-210
EYES
Unknown
Unknown
HAIR
Brown, Other
Black
COMPLEXION
Light
Dark
BUILD
Thin or Slender
Husky
SCARS FACIAL HAIR
Unknown
HAT COAT/
JACKET
PANTS
Blue
Blue
SHIRT
Blue
Red
SUSPECTED
OF USING


WEAPONS ( )
WEAPON
Personal Weapons
FIREARM
N
COLOR
N/A
MAKE
N/A
MODEL
N/A
CALIBER
N/A

PROPERTY (None Specified)

VEHICLES (None Specified)

Narrative
(Event and Action Taken)
A man wearing a "talak" (a sacred Hindu mark worn on the forehead) was assaulted by two men. During the assault, the men screamed
at the victim to "clean that off his head." When taken into custody, the men reported that "dotheads should go back where they came
from."

Sheet 4: Incident 4

Incident-Based Event Report

CLASSIFICATION OF EVENT
1. TYPE OF
REPORT
Offense
2. EVENT START
DATE/TIME
10-1-2013 1400
EVENT END
DATE/TIME
-
3. DATE OF
REPORT
10-1-2013
4. TIME OF
REPORT
1800
5.
DISTRICT
2D
6.
SECTOR
7.
PSA
206
8. COMPLAINT
NO.
13001025
9. EVENT LOCATION
ADDRESS
67 Gaston Ave.
POSITION
Inside of
CORNER/
BLOCK OF
N
10. REPORT
RECEIVED BY
Radio run
11. RADIO RUN AND EVENT
LOCATION SAME?
N
12. PROPERTY
TYPE
Public
13. EVENT NO. 1 14. EVENT NO. 2 15. EVENT NO. 3
16. FORCED ENTRY
N
17. POINT OF ENTRY
N/A
18a. METHOD USED
Other
18b. TOOLS USED
Bat
19. WEATHER
CONDITIONS
Clear
20. HATE CRIME? 21. SECURITY SYSTEM
Not Applicable
22. LOCATION TYPE
23. DESIGNATED AREA 1 24. DESIGNATED
AREA 2
GANG
RELATED?
N
INTRA-
FAMILY?
N
ABC
ESTABLISHMENT?
N
GROUP
HOME?
N
PD378
ISSUED?
N
CPO TPO
OUTSTANDING?
N/A
SUSPICIOUS?
N
OFFENDER
COUNT #


VICTIM ( ) COMPLAINANT (None Specified)/ REPORTING PERSON (None Specified)
1. Victim Name
Jaideep Singh
Related to Event(s)
1
Language Assistance
Needed?
N
Language Assistance
Needed for:
(None Specified)
Date of
Birth
3-15-40
Sex
Male
Home Address
48 Gaston Ave.
Residency
Home Phone
Other Phone
Race
Asian
Ethnicity
Asian
Occupation
Work Related
N
Business/School Address
Work
Phone
Additional Contact Reporting
Person
Y
Received Referral
Form
Y
Injury Code Describe Injury
Gunshot
Blunt force trauma
Where Taken By Whom? Amb # Injury Status


BUSINESS/AGENCY (None Specified)

MISSING PERSONS (None Specified)


SUSPECTS ( )







1. RACE
White
SEX
Male
Ethnicity
W - White
Related to
Events
1
Age Range
25-30
HEIGHT
5'9-5'10
WEIGHT
130-150
EYES
Unknown
HAIR
Brown, Other
COMPLEXION
Light
BUILD
Thin or Slender
SCARS FACIAL HAIR
Unknown
HAT COAT/
JACKET
PANTS
Blue
SHIRT
Blue
SUSPECTED
OF USING


WEAPONS ( )
WEAPON
Blunt Object
FIREARM
N
COLOR
N/A
MAKE
N/A
MODEL
N/A
CALIBER
N/A

PROPERTY (None Specified)

VEHICLES (None Specified)

Narrative
(Event and Action Taken)
An elderly pedestrian was taking a walk around his neighborhood when an assailant began violently striking his dastaar calling him a
"raghead" and "towelhead."

Sheet 5: Incident 5

Incident-Based Event Report

CLASSIFICATION OF EVENT
1. TYPE OF
REPORT
Offense
2. EVENT START
DATE/TIME
07-4-2013 0200
EVENT END
DATE/TIME
-
3. DATE OF
REPORT
12-16-2013
4. TIME OF
REPORT
0230
5.
DISTRICT
2D
6.
SECTOR
7.
PSA
206
8. COMPLAINT
NO.
13-023
9. EVENT LOCATION
ADDRESS
12 Academy St.
POSITION
Inside of
CORNER/
BLOCK OF
N
10. REPORT
RECEIVED BY
Radio run
11. RADIO RUN AND EVENT
LOCATION SAME?
N
12. PROPERTY
TYPE
Public
13. EVENT NO. 1 14. EVENT NO. 2 15. EVENT NO. 3
16. FORCED ENTRY
N
17. POINT OF ENTRY
N/A
18a. METHOD USED
Other
18b. TOOLS USED
Handgun
19. WEATHER
CONDITIONS
Clear
20. HATE CRIME? 21. SECURITY SYSTEM
Not Applicable
22. LOCATION TYPE
23. DESIGNATED AREA 1 24. DESIGNATED
AREA 2
GANG
RELATED?
N
INTRA-
FAMILY?
N
ABC
ESTABLISHMENT?
N
GROUP
HOME?
N
PD378
ISSUED?
N
CPO TPO
OUTSTANDING?
N/A
SUSPICIOUS?
N
OFFENDER
COUNT #


VICTIM ( ) COMPLAINANT (None Specified)/ REPORTING PERSON (None Specified)
1. Victim Name
John Doe
Azim Kameer
Related to Event(s)
1
Language Assistance
Needed?
N
Language Assistance
Needed for:
(None Specified)
Date of
Birth
4-4-60
10-18-55
Sex
Male
Male
Home Address
Residency
Home Phone
Other Phone
Race
White
Asian
Ethnicity
White
Asian
Occupation
Work Related
N
Business/School Address
Work
Phone
Additional Contact Reporting
Person
Y
Received Referral
Form
Y
Injury Code Describe Injury
Gunshot
Blunt force trauma
Where Taken By Whom? Amb # Injury Status


BUSINESS/AGENCY (None Specified)

MISSING PERSONS (None Specified)


SUSPECTS ( )







1. RACE
Black
Black
Black
Black
Black
Black
SEX
Male
Male
Male
Male
Male
Male
Ethnicity
Black
Black
Black
Black
Black
Black
Related to
Events
1
Age Range
25-30 - All
HEIGHT
5'9-5'10
5'10-6'0
5'9-5'10
5'10-6'0
5'9-5'10
5'10-6'0
WEIGHT
130-150
200-220
180-200
130-150
200-220
180-200
EYES
Unknown -
All
HAIR
Black - All
COMPLEXION
BUILD SCARS FACIAL HAIR
HAT COAT/
JACKET
PANTS
SHIRT
SUSPECTED
OF USING


WEAPONS ( )
WEAPON
Blunt Objects
FIREARM
N
COLOR
N/A
MAKE
N/A
MODEL
N/A
CALIBER
N/A

PROPERTY (None Specified)

VEHICLES (None Specified)

Narrative
(Event and Action Taken)
Six black men assaulted a white man and his Asian male friend with clubs, causing serious injury, as they were walking through a
residential neighborhood. Witnesses stated the victims were attacked because they were trespassing in a "black" neighborhood.
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