6114.3 Form

BOMB THREAT REPORT FORM

INSTRUCTIONS: If a recording device has been put in place and a threat is received by telephone, start the recorder immediately. Don t hang up the phone. If the caller hangs up, leave the phone off the hook. Be calm. Listen; do not interrupt the caller, notify colleagues of your activity by prearranged signal while the caller is on the line; ask to have the message repeated.

Date call received____________________   Time   __________

Exact words of person placing call ___________________________________________________________

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If the threat is received via E-mail, tell another employee to alert Central Office immediately as you record information and correspond with the sender using the questions below. ASK the following questions:

What time is the bomb set to explode? ________ How many devices are involved?______________

Where is each located? _______________ Floor _____________ Area ___________________________

What does the bomb look like? ____________________

Is it disguised? ____________ Concealed/Hidden _____________ In the open? ______________________

What kind of bomb is it? ____________  What will cause it to explode? __________________________

Why was it placed? ________________  How did it get into school? _______________________________

Who placed the bomb? _________________________________

Are you a current student ___Yes ___No        Are you a former student? ____Yes ___No

Where are you calling from?________________   What is your name?_____________________________

VOICE CHARACTERISTICS:                        BACKGROUND NOISE

__ Male  __ Female                                             __ Rapid  __ Music  __ Television

__ Adult  __ Juvenile    Age ___                           __ Giggling  __ Children  __ Restaurant

__ Intoxicated  __ Accent  __ Deep                     __ Airplane __ Office

__ Disguised  __ Nasal  __ Crying                        __ Traffic  __ Train

__ Angry  __ Broken  __ Squeaky                       __ Conversation

__ Slow  __ Sincere  __ Excited                           __ Machinery

__ Normal  __ Speech Problem  __ Stressed        __ Shopping Mall

__ Loud  __ Calm  __                                          Other, specify ____________________

NOTIFY THE FOLLOWING:

_____ State Police               _____ Fire Department

_____ Local Police              _____ Building Principal/Administration

_____ Superintendent            _____ Other, specify_____________________________

Additional Information: ____________________________________________________________

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Signature of Person Receiving Call: ___________________________   Date: ___________________