City of Madison, Wisconsin
| |Case Number: | |
|Further attention required at this address? | Yes | No |
|Address: | |
|First Attempt: |DATE: | |TIME: | |
|Second Attempt: |DATE: | |TIME: | |
|Third Attempt: |DATE: | |TIME: | |
|Actual Contact: |DATE: | |TIME: | |
|Interviewing officers directed to | | | |
|complete interview by? | | | |
| |INTERVIEWING OFFICER |IBM # |AGENCY |
| | | | |
| |INTERVIEWING OFFICER |IBM # |AGENCY |
|Is the scene visible from this location? | Yes | No |
|Approximate distance and direction from this address to crime scene: | |
Individual Information
|Name: | |
| |LAST NAME |FIRST NAME |MIDDLE INITIAL |
|DOB: | | | |
|Relationship to others | |
|interviewed/involved: | |
|Work: | |
|Address: | |
|Work Phone: | |Hours: | |
|Cell Phone: | | | |
Vehicle Information
|Vehicle: |PLATE: | |TYPE: | |
| |STATE: | |YEAR: | |
| |MAKE: | |MODEL: | |
| |COLOR: | | | |
|Owner/Primary Driver: | |
Others at Residence
|Name: | |
| |LAST NAME |FIRST NAME |MIDDLE INITIAL |
|DOB: | | | |
|Relationship to others | |
|interviewed/involved: | |
|Work: | |
|Address: | |
|Work Phone: | |Hours: | |
|Cell Phone: | | | |
|Interviewed: | Yes No |
Victim Information
Are you or any other members of your household acquainted with [victim(s)] who live at [crime scene]?
| |
How well do you/they know them?
| |
Who else resides at the (victim’s) address?
| |
What sort of reputation do each of them have in the neighborhood?
| |
Have you ever been inside the [crime scene]? If yes, when were you there last?
| |
Are you familiar with any daily routines at [crime scene]?
| |
Who was closest to [victim(s)] or other occupants?
| |
Do you know of anyone who may have visited [victim(s)/crime scene] recently?
| |
When/where was the last time you saw [victim(s)] or any other member of their household?
| |
ISSUES SURROUNDING VICTIM
Are you aware of any problems involving [victim(s)/crime scene]?
| |
Were [name] and [name] having problems in their relationship, at work or in some other way?
| |
Was there anyone the victim was afraid of or upset with?
| |
Does either [name] or [name] have enemies that you know of? If yes, get details.
| |
Are you aware of any person(s) who would wish to harm the victim and his/her family? If so, please provide details.
| |
Is there anyone you think might do something like this? (who/why)
| |
How long have you lived at this address?
| |
How long has the victim(s) lived at that address?
| |
Did anyone move into or out of the victim(s) residence recently?
| |
Neighborhood Information
What time is the mail delivered in the neighborhood?
| |
What time is the newspaper delivered in the neighborhood?
| |
Did you observe any service people in the neighborhood today or recently? (meter readers, repair persons, deliveries, etc.)
| |
Have there been any neighborhood events such as garage sales, parties, or other unusual events in recent weeks?
Garage Sales/Estate Sales Parties/BBQs
Carnivals/Fairs/Parades People Moving In/Out
Open Houses Flea Markets/Farmers Markets
Social Group Meetings Sport Leagues/Games
Other
What is the usual daily activity in this area (day and night)?
| |
Did you observe anyone/anything out of the ordinary today or in the recent past?
| |
Have you felt uneasy about anything in the neighborhood recently?
| |
Did you or any other member of your household have occasion to go by [crime scene] today or in the recent past?
| |
Do you recall seeing anyone in the vicinity of [crime scene] between [estimated time of incident]?
| |
Did anyone stop at your residence today? (who/when/why)
| |
Does your home have an exterior surveillance system?
| |
Are you aware if your neighbors have video or camera surveillance?
| |
Do you or your neighbors have dogs? Did they bark? At what time?
| |
Did you see any vehicles parked near [address]?
| |
Has anyone in the neighborhood been a victim of a crime in the past year? (any suspects)
| |
Is there anyone in the neighborhood who has been arrested or has had other negative police contacts?
| |
SOCIAL MEDIA
Are you aware of anyone who may have information or evidence relating to this incident? If so, please provide details.
| |
Have you seen or heard of any social media posts, blogs or other mentions on line about this incident?
| |
Additional Information
What were your activities during [estimated time of incident]? Who was with you?
| |
If appropriate, obtain consent to search the residence, vehicles, storage areas. (If consent obtained, attach consent to search forms to interview sheet.)
Consent to Search Obtained: Yes No
Name of Person Who Consented:
Areas Searched:
House Garage/Carport
Cars/Trucks Sheds/Outbuildings
Boats Trailers/RVs
Other
The best time to contact other residents who were not present at the time of this contact?
| |
Is there anything else that you can tell me that may be beneficial to this investigation?
| |
***THIS DOCUMENT IS INTENDED FOR NOTE TAKING PURPOSES ONLY.
A DICTATED/TYPEWRITTEN REPORT SHOULD STILL BE COMPLETED
COVERING THE INFORMATION CAPTURED ABOVE***
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