Please submit this form at the end of the month in which

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Louisiana Court Security Incident Report

Judicial Administrator's Office 400 Royal Street, Suite 1190 New Orleans, LA 70130-8101 FAX (504) 310-2587

LAJAO Staff Contact: Jennifer Eagan, (504) 310-2616, jeagan@

Please submit this form at the end of the month in which the incident occurred.

This form is for administra ve purposes only. If law enforcement a en on is needed, contact the local police or sheriff's department.

1. Information of Person Completing Form:

Last

First

Area Code and Phone

Title

Email

2. Type of Court: Appellate District City/Parish 3. Parish: __________________________________

Not related to a particular court type

Name of Court

or Courthouse/Court Building: _____________________

4. Incident Date: __________ Time: ________

AM PM

5. Type of Incident:

9. Who was the perpetrator in the incident:

Physical assault

Disorderly behavior

Name: ______________________________________

Bomb threat

Hostage situation

Threat

Type of threat: Verbal

Written

Judge, judicial officer, or court staff Attorneys, witnesses, or jurors

Other: _______________________ Prisoner escape attempt

Criminal defendant/juvenile respondent

Plaintiff/non-criminal defendant/respondent/petitioner

Family member/friend of party in the case

Member of public (unknown relation to any case)

Other: ___________________________________________

Was this individual charged as result of the incident?

No

Yes

Pending

Attempt to bring a weapon into the courtroom or court building Other: ________________________________________

6. Location of Incident:

Courtroom of: Chambers of: Staff offices of:

Judge

Other judicial officer (associate judge, magistrate, etc.) Judge

Other judicial officer (associate judge, magistrate, etc.) Judge

10. Was the incident reported to law enforcement?

No Yes, name of agency: _______________________________

11. Was this incident related to a particular case within the court?

Criminal Family

Civil Probate

Mental Health Juvenile

Not related to a particular case

Case Number: _________________________________ Style: ______________________________________

Clerk's office

Other judicial officer (associate judge, magistrate, etc.)

12. Description of incident: ___________________________________________

Holding area

___________________________________________

Parking lot

Public area of courthouse/court building (lobby, hallway, etc.) ___________________________________________

Other: __________________

___________________________________________

7. Was a weapon involved?

No Yes, identify all weapons involved:

Gun

Knife

Blunt object

Other: ________________________

8. Was anyone injured?

___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________

No Yes, type of injury: ________________________ ___________________________________________

If yes, was medical attention rendered? No Yes

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