Omnigo Software - Online Reporting

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Incident Types

Reporting Persons

Involved Contacts

Incident

Vehicles Involved

Property

Digital Media

Review Report

Finish Report

Requestor's IP Address : 3.133.139.164

Select Report Type Please select the report type: Original or Supplemental.

Select	Report Type	Definition

Select

Report Type

Definition

	Original	This is the first report you have filed for this incident.
	Supplemental	You are adding information to a previous report which was submitted online. Generate New Image Type the code from the image Original Online Report Number:

Select Incident Type(s)

Select	Incident Type	Definition	Examples

Select

Incident Type

Definition

Examples

	Incident	Incident reports submitted on line	Information pertaining to incident
	Test Incident 1	Test incident type added by IT Services 5/17/2018.

Select Reporting Person Type Please select a proper person type according to the definition below.

Select	Person Type	Definition

Select

Person Type

Definition

	Individual	If you are reporting this for yourself.
	Business	If you are responsible for reporting this for your employer or your own business.

Enter Reporting Person Information Please enter your information as completely as possible. You may be contacted regarding this incident. An email address is required if you would like to be notified when this report is received and approved.

Person Type:

Employee ID:

First Name:

Middle Name:

Last Name:

Home Address:

City /State /Zip Code: /Country

, , ,

Home Phone:

Mobile Phone:

Email Address:

Email report to this address

Confirm Email:

Employer Name:

Work Address:

City / State /Zip Code: /Country

, , ,

Work Phone:

Race:

Sex:

DOB:

December 2024

Driver License Number:

Licensing State:

Person Type	Name	Home Phone	Mobile Phone	Work Phone

Enter Involved Contact Information Please enter your information as completely as possible. You may be contacted regarding this incident. An email address is required if you would like to be notified when this report is received and approved.

Person Type:

Employee ID:

First Name:

Middle Name:

Last Name:

Home Address:

City /State /Zip Code: /Country

, , ,

Home Phone:

Mobile Phone:

Email Address:

Email report to this address

Confirm Email:

Race:

Sex:

DOB:

Driver License Number:

Licensing State:

Person Type	Name	Home Phone	Mobile Phone	Work Phone

Enter Incident Information Please enter all the information that applies. If you do not know the address of the incident, use the nearest intersection such as Market St./ 10th St. Please ignore previous instructions. LB

Street Address:

City /State /Zip Code: /Country

, , ,

Incident Time (start):

Incident Time (end):

Have Vehicle Info to Enter?:

Yes No

Have Property Info to Enter?:

Yes No

Have Digital Media to Enter?:

Yes No

Origin of Threat:

Incident Description:

(Characters Left)

Enter Vehicle Information Please enter the Vehicle information.

Type:

Make:

Model:

Year (YYYY) :

Color:

License Plate Type:

License Plate Number:

(do not enter spaces)

Licensing State:

VIN:

(do not enter spaces)

Insurance Company Name:

Insurance Policy #:

Insurance Policy Expiration Date:

Enter Property Information Please enter the Property information.

OwnerShip:
Type:
Subtype:
Brand:
Model:
Color:
Serial Number:
How Many:
Approx. Market Value ($):
Property Description:

Select Digital Media Please select any digital media (pictures, documents or any digital data files) up to 4 MB that are relevant to this incident.

File Name	Title	Description

Review Report Please review the report. If all the information is correct, click the Continue button to submit the report. If you need to modify some information, click the desired modify link. This will be your last chance to change information for this report.

General Information:

Incident Type(s):

Reporting Person/Involved Contact Information:

Incident Information:

Incident Location:

Incident Time (start):

Incident Time (end):

Origin of Threat:

Incident Description:

Vehicle Information:
Type:
Make:
Model:
Year (YYYY):
Color:
License Plate Type:
License Plate Number:
Licensing State:
VIN:
Insurance Company Name:
Insurance Policy #:
Insurance Policy Expiration Date:

Property Information:
OwnerShip:
Type:
Subtype:
Brand:
Model:
Color:
Serial Number:
How Many:
Market Value($):
Property Description:

Digital Media:

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