COURT FACILITY MONTHLY STATISTICAL SUMMARY REPORT
FISCAL YEAR:
.
DISTRICT NAME :
REPORTDATE
DISTRICT NUMBER:
REMARKS:
LEAD CSOBJTE SUPERVISOR
Page 1 of 3
.
USMS JSVCOTR SIGNATURE
(Seethe following pages for definitions.)
-
DATE SUBMITTED
CSO FORM OM
Section J
(REV.2/07)
- ~ltachment3(AJ
COURT FACILITY MONTHLY STATISTICAL SUMMARY REPORT
suspected offender to answer for a crime. Arrests or any custodial interngation though
not technically an "arrest" must be based on probable cause. To be actionable in the
event that such seizure is improper or unlawfid, there must be an intent on the part of the
arresting officer or agent to bring the suspect into custody. The s e i m or detention must
be undektood by theperson being arrested that hdshe is-under arrest.
I To keep from proceeding; to delay; to keep in custody, retain or withhold.
The act of forcibly disposseiing an owner of property under actual or apparemt authority
of law. Abo, the taking of property into custody of the court in satisfaction of a
judgement or in consequence of a violation of public law.
To hold with limits.
The act of ddcting or the fact of being detected.
An occurrence or event that intempts normal procedure or precipitates a crisis.
Reporting an incident on the ~ourtkacility
h4&thly statistical Gmmary means that you
must also submit a copy of the corresponding Court Facility Incident Report (CSO form
003) to the Judicial Security Division (JSD), Ofice of Court Sccurity (OCS), Operations
Support Branch (OSB). ALI, COURT FACILITY INCIDENT REPORTS MUST BE
FORWARDED TO OCS OSB WlTHM 24-HOURSAFTER THE INCIDENT
I
DETAINMENT
SEIZURE
.
RESTRICTIONS
DETECTIQN
INCIDENT
OCCURS.
CONTRABAND
WEAPON
LEGAL
ILLEGAL
PROH~B~TED
ITEM
ABANDONMENT
KNIFE
GUN
CONFISCATE
.
WEAPONS OFFENSE
Page 2 o f 3
-
Any property or possession, the transportation of which is ILLEGAL. For instance,
narcotic drugs, fuearms, etc. When conhaband is discovered pn a court visitor, detain
the subject and immediately call a DUSM to the scene. Prepare a Court Facility Incident
Report (CSO Fom 003) to describe the situation. The report must address who, what,
where, when and how.
Any instrument capable of producing death or serious bodily injury. An.instrument may
be intrinsically deadly (e.g. knife, pistol, rifle) or deadly because of the way it is used or
the force withwhichit is kied (e,g., wrench, hammer, stick).
Authorized by or based on law. Enforced or recognized by law. Create4 by law.
Forbidden by law or by official rules.
Any item listed as mhibited in the court facility by order of the Chief Judge or the U.S,
. .
I~akhal.
I Knowing relinquishmentof one's right or claim to property without any future intent to
again gain title or possession. Relinquishment or surrender of rights or property by one
person to another. Intent to abandon and the act by which the intention is carried out. A
finder of the property not legally abandoned must make reasonable efforts.to restore it to
the true own& i d must relinquish it to himher upon demand.
A cutting; instrument havim a sharp blade with a handle.
Any device, whether apparent or disguised, capable of firing an explosive charge used as
a propellant for a projectile.
To take private property without just compensation. To transfer property from a private
use to a public use. To appropriate private property as a result of a criminal conviction
I or because the possession was itself, a crime.
I Violations of statutes or regulations that control weapons.
CSO FORM 002 (REV.02/01)
Sectbn J Attachment 3(A)
-
COURT FACILITY MONTHLY STATISTICAL SUMMARY RXPORT
,ECA L (non LE.0)
IETECTED, STORED,AND
lETURNED
LLEGAL
2OURT FACILITY INClDENT
WREST REPORT
PROHIBITED ITEM
(LEO)
weaponsin this category. '(varies by state.)
weapons should
Self explanatory. The quantity of "STORED" and "RETURNEDn
match.- lf they do not, you should immediately make inquiries to determine why they
don't match.
Use these blocks to identify CONTRABAND carried ,by persons who are NOT legally
authorized to possess or &sport it. (Varies by state.) When contraband is discovered,
immediately detain the person(s) involved, call a DUSM to the scene, prepare a Court
Facility Incident Report, and include the report on the C u t Facility Statistical Summary
or
report. Provide name and date of birth of perpetrator.
Use this field to report the quantity of C u t Facility Incident Reports pre'pared during
or
the reporting period. Any time there is an ILLEGAL item confiscated from a court
visitor there should be a corresponding incident and/or arrest report. Copies of Incident
and/or arrest reports must be sent to JSD/OCS-OSB with 24-hours after the incident
occurs. Be sure to include copies of Incident Reports with the monthly Court Facility
Statistical Silmrnary report submission.
Use this field to report the quantity of arrest reports prepared as a result of a violation of
the building secur& regulations. ~ r r e srePo& wili b$ppared by a DUSM. A copy o
t
f
the An-est Report@)should be sent with the Court Facility Statistical Summary Report
and sent to JSD/OCS-OSB.
This field contains a list of some but not all items that may be prohibited in the court
facility. If other non-identified items afe detected and stdred, i o u may identify them in
the vacant spaces at the bottom of the list. Be sure to verify that the number of items
stored matches the number of items returned. If thev do not match.- vou must
immediately make inquiries to determine why they don't match.
Number of hours charged during the reporting period by Court Security Officers in
performing their duties in the categories listed.
Use this field to report the quantity of Court Facility Incident Reports for the type of
incidents listed. (e,g,, 2 Bomb Threats, 7 Assaults, etc.)
-
ZSO HOURS
WPE OF INCIDENT
Page 3 of 3
CSO FORM 002 (REV.02\07)
Section J Attachment 3(A)
-
COURT FACILITY INCIDENT REPGfiT
. DATE OF REPORT
2. DATE OF INCIDENT
4. ARRESTfDETIENTION
5, REPORTING DlSTRlCT
3. REPORTED BY (Piweprinf):
6. LOCATION OF INCIDENT
~ i p
a
NO
1
r, TYPE OF INCIDENT (Check Applicable Box)
1Bomb Threat 0 Assault
aForced Entry
I
7 Illegal Weapon
[ IOther (Describe)
I
YES
Contraband
C] Shooting
Medical Emergency
State
Disruptive Person
1. CHECK APPLICABLE BOX
INITIAL REPORT
1.
FOLLOW-UPREPORT
a
ADDENDUM
(Initial report dated,
INCIDENT DESCBXPTlON (Detailsshould cover who, what, where, when and how.)
LO, REPORT PAGES
REPORT CONTINUED ON
ATTACHED PAGE@).
I hereby certify that the informatbn stated herein is true, complete and accurate to the best of my knowledge.
II. SIGNATURE OF PREPARER
12. DATE
15. DISTRIBUTION
-
DISTRICT COTR 1 COPY
1 . APPROVED BY:
3
14.
DATE
VAME
SEE NE.XT PAGE FOR lNSTRUCTION5
PAGE 1 of 3
CSO FORM 003 (REV,02/07)
Section J Attachment 3(B)
-
COURT FACILITY INCIDENT REPORT
(Continuation Sheet)
I.
DATE O F REPORT
2. DATE OF INCDENT
I
3 PAGE(s)
.
OF
I
[NCIDENT DESCRIPTION (Details should cover who, what, where, when and how.)
SEE NEXT PAGE FOR LNS7RUCTIONS
PAGE 2 o f 3
CSO
003 (REV.02/07}
Section J - Attachment 3(B)
SEE NEXT PAGE FOR ZNSTRUCTlONS
PAGE 3 of 3
CSO FORM 003 (REV.02/07) .
Section J
- AItachtuen! 3(B)
COURT FACILITY INCrOENT REPORT
I. DATE OF REPORT
1. DATE OF INCiDENT
3. REPORTED BY
8. ARRESTlDETENTlON
5. REPORTING DISTRICT
5 rnCATION OF INCIDENT
.
7. TYPE OF INCIDENT
8. CHECK APPLICABLE BOX
P.
INCIDENT DESCRIPTION
State the date the report is being prepared.
Self explanatory.
Provide the name of person prepaxing the report.
Check the box at the bottom of this section if anyone is detained for any length of
t m or prrested.
ie
Indicate the name afthe district pteparink the report. Please annotate if different
*
than where the incident occurred,
Indicate the city and state where the incident occurred.
Check applicable box that best describes the type of incident. If "Other" is checked,
give a one or two word description that best describes the incident.
Indicate whether this is an initial report, a follow-up or an addendum to a previous
report.
At a minimum,the report must address the foIlowing:
W O Provide the name(s) of the person{s) involved and their date of birth.
H:
W m T : Describe what happened in detail.
WHERE: W e e did the incident happen7 City, building, floor, room, etc.
hr
WHEN: Date and time of the incident.
HOW: If not already covered in the "what" category,describe how the incident
happened.
All reports must be legible, complete, and accurate as poaible. Explain the incident
in detail, from the beginning to the end. Never end in the middle of the story.
BE SURE THAT THE REPORT CAN BE READ BY SOMEONE OTHER THAN YOU.
10. REPORT PAGES
II. SIGNATURE OF PREPARER
12. DATE
13. APPROVED BY
14. DATE .
15. DISTRIBUTION
PAGE 3 OF 3
If the narrative describina the incident is included on additional - - - write the
panes,
number of pages attached. If contents.of the report arc sensitive in nature, each page
should be marked "FOR OFFICIAL USE ONLY."
Self explanatory.
Enter the date you signed this report.
Indicate the name and title of the Contractor's official reviewing and approving
official.
NOTE: The reviewing and approving official must be a supervisory representative.
Enter the date the report' was reviewed, approved, and signed by the contractor's
supervisory representative.
Immediately forward a copy of this report as indicated,
CSO FORM 003 (REV. 02/07)
Secrlon J Attachment 3(E)
-
-
1 VOUCHER TYPE
VOUCHEROATE
I
17
ll
1
CONTRACTOR'S NAME
Original
Reclaim
TRlP BEGINS ON:
I
M
~
:
FIRST
.
M
Lodging and M&lE $
I
Transportation
$
Other
NAME:
$
LAST
ADDRESS:
-
TRlP ENDS ON:
CITY:
STATE:
ZIP CODE:
DISTRICT LOCATION:
SSN:
a
s l l tSECUWTY ASSIGNMENT
?XA
OTHER*
TRAVELA UTHORI.34 TION:
YOU AREAUTHORIZED
TRAVEL AT -EN
EXPENSE IN ACCORDANCEY\OTH DEPARTMENT OF JIJSTJCEREGULATtONS UNDER THE CONDITIONS OVnlNEO IN THIS AUrrlORIZATtONAS NECESSARY
NAME (Pffnt)
APPROVAL DhTE
SIGNATURE
~TLE
APPROVAL DATE
SIGNATURE
CSO FORM 010 (EST. 09/61)
Section J Attachment 3 C
()
-
COURT SECURITY OFFICER (CSO) TRAVEL EXPENSE REIMBURSEMENT
f RAVGLER DATEAND SIGN HERE
I hereby certiCy that the travel undataken in this
reimbursementvoucher is h e and accurate to
the best of my knowledge and that paymentor
credit has not been received by me.
2. BUSINEM CLASS n 3.~NRm
CLASS o 4.
WA
R W O N FOR UPGRADE (Required ifBusinessor First Class i d.)
s
PRINTED NAME:
SIGNATURE:
.
I hereby certify that the mvef undertaken in this
reimbursementvoucher has been reviewed and
approved as necesssry for the conduct dUSMS
contract business.
SUBMISSION DATE:
1 COACH
.
CONTRACTOR'S APPROWNG OFFlClAL OATE AND SIGN HW
SUBMISSWN DATE:
t
.
ORIGINAL
RECWM
1 Cost for Air, Train, Bus, ek.
Car Rental and Gas
!
§
Privately Owned Vehicle (P0V)IMileage Total
Public Transportation- Temporary Post Assignment
Lodging
S
I
1 Meals and Incidental Exoenses
Parking
Other
Page 1of 2
$
I S
1
1 %
I
$
CSO FoRM 01I (EST. 01/04)
Section J Attachment 3@)
-
Slan*nl Fnrm 1034
R w i dOmbn l a 7
Dcparlrncnl of I T m r y
k
1 TFM 4 . 2 ~ 1 0
VOUCHER NO.
PUBLIC VOUCHER FOR PURCHASES AND
SERVICES OTHER THAN.PERSONAL
U.S. DEPARTMENT. BUREAU. OR ESTABUSHMENT AND LOCATlON
DATE VOUCHER PREPARED
SCHEDULENO.
CONTRACT NUMBER AND DATE
PAID BY
I
REQUlSlTlON NUMBER AND DATE
PAYEE'S
DATE INVOICE RECEIVED
NAME
AND
DISCOUNT TERMS
AWRESS
PAYEE'S ACCOUNT NO.
SHIPPED FROM
,
.
NUMBER
AND DATE
OF ORDER
.
-
DATEOF
DELIVERY
OR SERVICE
ARTICLES OR SERVICES
(Enter dwcriptlan, ltun number ~connrrct Ftdaul
or
nrpply rrhcdulr. and other informarion deemed nccmmrjl
]
Trm
COST
TOTAL
PER
AMC)VN1*(I)
1
I
1 EXCHANGE RATE
APPROVED FOR
UNIT
QUAN-
(Payee mu+ ROT ase Ihc rpxe beton)
(USCcontinuation sh0011) if necessary}
PAYMENT:
GOVERNMENT BIL, NO.
WEIGHT
K)
DIFFERENCES
TITLE
Pursunrn t authority mrd in m i 1ccnify that this mucha i s -1
o
Date
and proper for pymtnt.
Authorized Ceaifying Offlc~r
(2)
-
- -
(Tide)
---
..
.
-
ACCOUNTING CLASSIFICATION
CHECK NUMBER
fi
2
CASH
ON ACCO?
*
OF U.S. TREASURY
.
CHECK NUMBER
I
DATE
ON (Name dbank)
I
. . PAYEE 3
I
( 1 ) Whcn nuid in rolrigncurrmcy, sutc nomcofeumney
(2) Ii'lhc n 8r 1 emiFyand nahuiwto rppmwm cornbind in one omon. one
h lv 0
rirplrlure unly ir ncrarsiry; ntknvixlhs np+avingamcor will vian in ik ~pnc~prn~idod,
DVU hixlher rrmcial title.
I31 When o vouchw is nvciplrrl in rhc mmc O h company vrcorporalim,the namoTthe
pnan writing Ihe company or cnrpunlt rwne as well u the capacity in which h d s k r i p ,
mvrl rppw. Fw cxrmple: John Doc Compuny, p r John.
PBR
TITLE
.
PRIVACY ACT STATEMENT
Thc informationrcqucstod on thir form i! mquircd undei thc pmvisior~~ 3 I U.S.C. and 82c, fw tha purpoa~
of
82b
of
disbursing F~deral
moncy, 'Ihc infom!ton rsqucScd i s lo idcntif'ytho panicufar orcditor and rhc arnaunlr l o bc pa~d.
Failum
to furnish h s informatian will h~nder
dzschsrgc ofme paymcni obligslion
... . -
. .. .-.- ----
I1
VOUCHER NO.
PUBLIC VOUCHER FOR PURCHASES AM)
SERVICES OTHER THAN PERSONAL
I
I
IDATE VOUCHER PREPARED
U.S. DEPARTMENT, BUREAU. OR ESTABLISHMENT AND LOCATION
SCHEDULE NO.
I
COh%Uff NUMBER AM) DATE
PAIDBY
,
REQUISITIONNUMBER AND DATe
PAYEE'S
NAME
AND
ADDRESS
PAYEE'SACCOUNT NO.
SHIPPEDFROM
NUMBER
AND DATE
OF ORDER
'PO
DATEOF
ARTICLES OR SERVICES
(Enter dedcriprion, irm itumbvo/curilract or Federal
supply schedule, and other i@~rmariondeemed necrrnrryj
DELIVERY
OR SERVlCE
APPROVED FOR
PROVISIONAL
COMPLETE
'
BY (2)
GOVERNMENT BL NO.
-
UNIT.
COST
PER
AMOUNT(!)
TOTAL
EXCHANGE RATE
=s
.
QUANTIT~
(Payee mu* NOT use Ihe apm below)
(Usc conrinuationshkls) if nccassary)
PAYMEW:
WE~GHT
DIFFERENCES
=SI.@n
.
I
Amount vcnbcd: carrcn for
TITLE
I
(Signarum or initials)
ADVANCE
.,
.
I
MEMORANDUM
Pu~uanr authority vcstcd in mc. I catiFy that this vouchcr i s corrcc1md pmpcr for p a y m a .
to
AulhorizedCertifying M f i0
1
Datf
h
CHECK NUMBER
(Title)
ACCOUNllNG CLASSIFICATION '
ION ACCOUNT OF U.S. TREASURY
CHECK NUMBER
I
1 ON flame olbank)
in
5
a
CASH
DATG
PAYEE
PER
PRIVACY A f f STATEMENT
Thc infmation rcquestcd on LP form is requiredundm me pmvisionsor31 U.S.C. 82b and 82c. for thc
disbursing Fodcral moncy. Thc information r q t i to idcnti Ihc particularcrcdicor md the mounts to
c md s
ro hrnirh this inrorrnarion will hindsr discharge of the paymcnr chgatlon.
ptd Failure
of,
1
SF-I034
10187
USMS 07/05
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