CRIME INCIDENT REPORT FORM

The following form can be used on-line to report to the JSA any criminal or suspicious incidents against jewelry firms. By clicking the SUBMIT button at the end of the form, the information provided by you will be sent to the JSA as an e-mail. This will not be an anonymous report since your e-mail address will appear on the report. This form can be printed to be submitted anonymously, or to be submitted at a later time via mail, fax, etc. The JSA welcomes any report of a crime incident in any form. The report form below is not a required text, it is only a suggested format.
CONFIDENTIALITY
PRIVACY STATEMENT
The Jewelers Security Alliance is committed to maintaining the privacy of those who use and report information on stolen jewelry through this website. Information reported to JSA will only be used to facilitate the investigation, identification and recovery of stolen jewelry, and will only be provided to those with a need to know, such as law enforcement personnel.
Name of Person Submitting Report
Company Name:
Contact Person:
Mailing Address:
Additional Address Info:
City:
State: Zip:
Country:
Phone Number:
Fax Number:
Email Address:
required for response
Victim Information(if different from person submitting
Name of Victim:
Company Name:
Contact Person:
Mailing Address:
Additional Address Info:
City:
State: Zip:
Country:
Phone Number:
Fax Number:
Email Address:
required for response
TYPE OF INCIDENT (Choose one)

Robbery

Involves use or threat of using force, fear, weapons or violence.

Theft
Taking of property by stealth, trickery, fraud, shoplifting, bogus checks, credit card fraud, shipping losses.

Burglary
Taking of property from a closed, locked premises.

Traveling Salesperson
Where victim is a traveling sales representative or other jeweler transporting goods outside of main business location. Any off-premises incident.
DETAILS OF INCIDENT
Date & Time of Incident:
Attempted or Actual?: Attempted Actual
Amount of loss (Specify wholesale or retail value):
Amount of loss ($): Wholesale Retail
Value of merchandise recovered:


Narrative of Incident (Include as much detail as possible as to what the suspects did, what they said, how they acted, was anyone injured, did anyone resist, do you have video cameras, were the cameras & video recorder functioning, etc. If incident occurred off-premises include the exact location, type of location, stops made prior to incident from which victim may have been followed, etc.).

 
SUSPECT INFORMATION

Description of Suspects: Include sex, age, race, eye and hair color, hair length & style, accent, height, weight, scars, moles, tattoos, glasses, clothing & jewelry worn, or any other distinguishing features.
Names Used by Suspects (even if false.):
Vehicles used by Suspects:
Make:
Model:
Year:
 
Color:
License Plate:
Are video, photographs, or composite sketch of incident available? Yes No
 
LAW ENFORCEMENT ACTIVITY
Was Incident Reported to Police?
Yes No
Name of Detective assigned (not reporting officer):
Phone # of Detective assigned:
Date of Arrest, Conviction, Length of Sentence:
or