BPA F 5632_18e Crime Witness Telephone Report

BPA F 5632.18e
U.S.
(11-2020)
(Prior editions unusable)
Page 1 of 2

DEPARTMENT OF ENERGY- BONNEVILLE POWER ADMINISTRATION (BPA)

CRIME WITNESS TELEPHONE REPORT

OMBControl Number: 1910-5188
Expiration Date: 08/31/2022

For Security Use Only

Instructions: Please fill out this form and e-mail as an attachment to Kevin West – NNT- MODD , Richard Schuch – NNT- 1 and
Ken Worstell-NNT-MODD. Always remember if there is a crime in progress call 911. If calling from a BPA extension dial 6-911 from Van
Mall, 7-911 from Headquarters, or 8-911 from Ross.
Contacts: Kevin West – 360-418-8243, Richard Schuch – 503-230-5259 and Ken Worstell-360-418-8017.

A. Incident Information
1. Incident Date:

2. Report Date:

3. Caller Name (Last, First and Middle Initial):

4. Location of caller:

5. Type of Incident (Check all boxes that apply):
Alarm
Gun Shots
Dumping

Auto Accident
Prop. Damage
Other

Homeless Camp
Safety Hazard

Emergency
Susp. Person(s)

Fire
Theft

Injury
Trespasser(s)

Open Door
Vehicle

6. Describe any injuries:

7. Describe any property damage:

8. Approximate Time of Incident:
a.m.
p.m.
10. Latitude/Longitude:
13. Did the witness call 911?

11. GPS Grid:

Yes

15. Police Time Arrived:
a.m.

9. Exact Location of Incident (Address, City, State, County and Cross Street):
12. Other landmarks or direction:

No

14. If yes, time notified:

16. Police Officer’s Name:

a.m.

p.m.

17. Police Case Number:

p.m.

18. Time Departed:

19. Incident Commander:

a.m.

p.m.

B. Witness Information
20. Name (Last, First and Middle Initial):
23. Is the witness willing to testify?

21. Phone Number:
Yes

22. Email Address:

No

C. Suspect Information
24. Name (Last, First and Middle Initial):
26. Height:

27. Weight:

25. Phone Number:
28. Hair Color:

29. Eye Color:

30. Gender:

31. Race:

32. Clothing Description:

D. Suspect Vehicle Information
33. Vehicle Identification Number (VIN):
38. Model:

34. Plate Number:
39. Style:

35. State:

36. Year:

37. Make:
40. Color:

41. Additional vehicle details:

42. Other Confidential Informant Information (To be provided by the informant at their option; explain that this information is requested only for the
purpose of disbursing of monetary reward.)

43. Other Suspect Information

File Code; SS-18-15 Retention; NT=10yrs

BPA F 5632.18e
U.S.
(11-2020)
(Prior editions unusable)
Page 2 of 2

DEPARTMENT OF ENERGY-BONNEVILLE POWER ADMINISTRATION(BPA)

CRIME WITNESS TELEPHONE REPORT

OMB:1910-5188
Expiration Date: 08/31/2022

For Security Use Only

44. How did the caller hear about the Crime Witness Hotline?
Newspaper/magazine

Law enforcement

Radio/TV

Web page

CW published Ad

Individual

Posted sign/notice

Phone Book

Other
45. Narrative of incident (who, what, where, why):

46. Report Taken By (Name and Title):

47. Date:

Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to ensure the security and safety of BPA employees, contractors, and facilities. The data you supply will be used by BPA
Security when collecting information from a witness to a crime, via telephone. Public reporting burden for this collection of information is
estimated to average .10 hours per response, including the time for reviewing instructions, searching exiting data sources, gathering
and maintaining that data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer,
Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project (OMB control number 1910-5188), U.S.
Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget
(OMB), OIRA, Paperwork Reduction Project (OMB control number 1910-5188), Washington, DC 20503.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to
comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays
a currently valid OMB control number.
The Paperwork Reduction Act (PRA) of 1995 requires each Federal agency to seek and obtain approval from the Office of Management and Budget
(OMB) before undertaking a collection of information directed to 10 or more persons of the general public, including persons involved in or supporting
the operations of Government-owned, contractor-operated facilities.
Submission of this data is required.

File Code; SS-18-15 Retention; NT=10yrs