Security Incident Report Form Louisiana
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1Louisiana Court Security Incident Report
Judicial Administrator’s Offi ce
400 Royal Street, Suite 1190
New Orleans, LA 70130-8101
FAX (504) 310-2587
LAJAO Staff Contact: Jennifer Eagan, (504) 310-2616,
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
AM
Name of Court
4. Incident Date: __________ Time: ________
_____________________
or Courthouse/Court Building:
PM
5. Type of Incident:
9. Who was the perpetrator in the incident:
______________________________________
Disorderly behavior
Physical assault
Name:
Hostage situation
Bomb threat
Criminal defendant/juvenile respondent
Threat
Plaintiff/non-criminal defendant/respondent/petitioner
Type of threat:
Written
Verbal
Family member/friend of party in the case
Judge, judicial offi cer, or
Member of public (unknown relation to any case)
court staff
Other: ___________________________________________
Attorneys, witnesses, or jurors
Was this individual charged as result of the incident?
Other: _______________________
No
Yes
Pending
Prisoner escape attempt
10. Was the incident reported to law enforcement?
Attempt to bring a weapon into the courtroom
or court building
No
Other: ________________________________________
Yes, name of agency: _______________________________
6. Location of Incident:
11. Was this incident related to a particular case
Courtroom of:
Judge
within the court?
Other judicial offi cer (associate
Criminal
Civil
Mental Health
Not related to a
judge, magistrate, etc.)
Judge
particular case
Chambers of:
Family
Probate
Juvenile
Other judicial offi cer (associate
_________________________________
Case Number:
judge, magistrate, etc.)
______________________________________
Judge
Staff offi ces of:
Style:
Other judicial offi cer (associate
12. Description of incident:
judge, magistrate, etc.)
___________________________________________
Clerk’s offi ce
Holding area
___________________________________________
Parking lot
___________________________________________
Public area of courthouse/court building (lobby, hallway, etc.)
___________________________________________
Other: __________________
7. Was a weapon involved?
___________________________________________
Yes, identify all weapons involved:
No
___________________________________________
Gun
Knife
Blunt object
___________________________________________
Other: ________________________
___________________________________________
8. Was anyone injured?
___________________________________________
Yes, type of injury: ________________________
No
If yes, was medical attention rendered?
No
Yes
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