1.

TYPE

OFFENSE/INCIDENT REPORT
INSTRUCTIONS ARE PRINTED SEPARATELY. IF ADDITIONAL SPACE
IS NEEDED, USE REVERSE OF FORM; IDENTIFY ITEMS.
2. CODE NO.

2a. SORT

6. ADDRESS

7. NAME OF AGENCY/BUREAU

8. AGENCY/BUREAU CODE

11a. DATE OF OFFENSE/INCIDENT

9. SPECIFIC LOCATION

11a. TIME OF OFFENSE/INCIDENT

VEDINVOLNSPERSO18.

12.
DAY

10. LOCATION CODE

13a. DATE REPORTED

16. NO. OF DEMONSTRATORS

CONCURRENT

PARTIAL

PROPRIETARY

13b. TIME REPORTED

17. NO.
EVACUATED

NAME AND ADDRESS

(b)
Last Name, First, Middle Initial

a. TIME START

AGE
(c)

SE
X
(d)

RA
CE
(e)

INJURY
CODE
(f)

TELEPHON
E
(g)
HOME

BUSINESS

Number, Street, Apt. No., City and State

19. VEHICLE

a. STATUS

c. MAKE

GOVT

PERSONAL

VANDALIZ
ED

RECOVERED

e. COLOR (Top/Bottom)

f. IDENTIFYING CHARACTERISTICS

g.
REGISTRATIO
N

d.
MOD
EL

SUSPECT

STAT
E

TAG
NO.

h. VIN

i. VALUE

a. NAME OF ITEM

b. QUANTITY

e. SERIAL NO.

f. COLOR

g. MODEL

i. UNUSUAL OR UNIQUE FEATURES

j. PROPERTY WAS

k. STATUS OF PROPERTY
RECOVERED

c. OWNERSHIP
GOVT

h. VALUE

SECURRED
UNSECURED

MISSING

PERSONAL

d. BRAND NAME

VALUE RECOVERED

PARTIAL RECOVERY

l. NAME OF ITEM

m. QUANTITY

p. SERIAL NO.

q. COLOR

r. MODEL

t. UNUSUAL OR UNIQUE FEATURES

u. PROPERTY WAS

v. STATUS OF PROPERTY
RECOVERED

21. NARRATIVE (If additional space is needed, use blank sheet and attach.)

n. OWNERSHIP
GOVT

s. VALUE

SECURRED
UNSECURED

b.
YEAR

STOLEN

HOME
BUSINESS

YEAR

TAKEN 20. ITEMS

b. TIME END

14. DAY

Number, Street, Apt. No., City and State

Last Name, First, Middle Initial

c. SUPPLEMENT
OR FOLLOWUP

4. CASE CONTROL NUMBER

15. JURISDICTION (X)

ID
CODE
(a)

b. CONTINUATION

3. TYPE OF OFFENSE OR INCIDENT

5. BUILDING NUMBER

EXCLUSIVE

a. ORIGINAL

MISSING

PERSONAL

PARTIAL RECOVERY

o. BRAND NAME

VALUE RECOVERED

GSA FORM 3155 (REV. 3/200)

GENERAL SERVICES ADMINISTRATION

23a. EVIDENCE

TIME

22. NOTIFICATION

NOTIFIED

YES

ARRIVED

a. Other Police
Agency

b. Fire Department

c. Ambulance

NO

23b. TAG NO.

23c. TYPE

23d. WHERE STORED

24. ATTACHMENTS (Mark X where applicable)

a. CONTINUATION SHEET

b. GSA FORM 3157

c. PROPERTY RECEIPT(S)

e. SUPPLEMENTAL

e. OTHER (Specify)

25. SUSPECT STATUS

26. DISPOSITION OF SUSPECT

a. NOT IDENTIFIED

a. ARRESTED

b. GOVERNMENT EMPLOYEE
c. GOVERNMENT CONTRACT

c. RELEASED

d. NON-GOVERNMENT EMPLOYEE

d. STATEMENT(S)

f. OTHER ATTACHMENTS (Specify)

d. Building Manager

b. NOT ARRESTED

d. N/A

CITATION NUMBER

d. CITATION ISSUED

e. N/A

NOTE: Complete GSA Form 3157 where this is a Suspect, Att. Burglary, Burglary, Att. Robbery, Robbery, or a Weapon is used.
27. TIME
a. RECEIVED

28. REVIEWED BY

b. ARRIVED

a. TYPE
FPS

c. RETURNED TO SERVICE
29a. BADGE

b. SIGNATURE

d. DATE

c. NAME (Printed)

GG

29b. NAME (Printed)

29c. SIGNATURE

29d. DATE

30. CASE REFERRED TO

a. FPS
DETECTIVE

b. LOCAL
POLICE

d. FBI

e. IG

31. CASE

c. STATE POLICE

32. APPROVING OFFICIAL

a. SIGNATURE

a. OPEN

g. OTHER (Specify)

b. CLOSED

c. NAME (Printed)

c. UNFOUNDED

f. N/A

b. DATE

33. DETECTIVE STATUS

a. CASE NUMBER

b. HOW CLOSED
INACTIVE
MEANS

c. SUSPECT
ARREST

OTHER

f. VALUE OF PROPERTY
e. PROPERTY
RECOVERED

d. ENTERED NCIC

DEVELOPED

ARRESTED

g. CLEARED NCIC

YES
h. REFERRED TO

YES

NO

N/A

i. DATE REFERRAL ACCEPTED

21. NARRATIVE (If additional space is needed, use blank sheet and attach.)

NO

N/A

GSA FORM 3155 (REV. 3/200) PAGE 2