Campus Security Authority Report Form

College employees who have responsibilities outside of the academic classroom for student and campus activities, including but not limited to student housing, student discipline, and judicial proceedings, may be designated as a Campus Security Authority. A CSA has responsibility to report incidents.

CSAs may include but are not limited to:

  • Deans, Directors, Department Heads, Supervisors
  • Safety & Security Staff
  • Merchant Patrol
  • Club Advisors
  • Human Resources Staff
  • Athletic Staff, Including Coaches
  • Student Life Staff

Centralia College requires each Campus Security Authority to report to Campus Safety & Security when they become aware that a Clery Act incident may have occurred. Clery Act incidents include sex offenses, robbery, other violent crimes, such as dating and domestic violence, drug abuse violations, and liquor law violations that result in either an arrest or a disciplinary referral, and any crime considered to be motivated by hate or bias. To report such a crime or crimes, please fill out the form below.

For Emergencies, Dial  911

The CSA Report form is intended to provide CSAs with a method of reporting Clery crimes to Campus Safety & Security for inclusion in the college’s annual compilation of Clery statistics.

The CSA Report form is not a method of notifying police of an emergency, dangerous situation, or other hazard. The submission of the CSA Report will not prompt a police investigation or generate an official police report or case number.  In the event of an emergency call 9-1-1. 


360-623-8888 Reporting Line