BC 1206 Bc1206
User Manual: BC-1206
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U.S. DEPARTMENT OF COMMERCE FORM BC-1206 (11-8-99) CENSUS SECURITY OFFICE USE ONLY 1. Incident Economics and Statistics Administration U.S. CENSUS BUREAU Date Time a.m. SECURITY INCIDENT REPORT p.m. 2. Report Time Date a.m. p.m. Date received – Stamp 3. Complete address where incident happened (Street, city, State, ZIP Code) OR (Room/Building) 4. Person completing report a. Name c. Telephone number b. Signature d. Division or Region Area code Number e. Building 5. Type of incident ADP Assault Theft – Government Theft – Personal 6. Was medical attention received? Other – Explain Yes No 7. Details of incident – If additional pages are needed, mark (X) this box and attach. 8. Who was notified of incident – Mark (X) all boxes that apply Police F.B.I. Sheriff FPO Supervisor Census Security Office Division/Regional Security Representative 9. Police report number (If applicable) Administrative Office Other – Specify Attached 10. Persons involved in incident – Attach additional pages, if necessary. Codes for column (a): W – Witness V – Victim or Complaintant O – Investigated by Code Name (a) (b) Telephone (c) Area code Number Will follow M – Medical personnel Street, city, State, ZIP Code (d) CENSUS SECURITY OFFICE USE ONLY 11. Disposition of incident – If additional pages are needed, mark (X) this box and attach. 12. Signature of person closing this incident f. Room No. 13. Date incident was closed 14. Incident number
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