Sample Format of CSI Form 1 First Responder's Form
Sample Format of CSI Form 1 First Responder's Form
____________________
Date
THIS IS TO CERTIFY that the Crime Scene (CS) described hereunder was turned over
by the First Responder (FR) to the Duty Investigator /Investigator-On-Case (IOC) with the
following gathered information:
___________________________________________________________________
__________________________________________________________________
__________________________________________________________________
F. Names of Persons Who Entered the CS after the Arrival of FR and Prior to Arrival of
Investigator (Medics, Local Officials, etc) (Address/Contact Nr):
_________________________ __________________________________
_________________________ __________________________________
_________________________ __________________________________
_________________________ __________________________________
_________________________ __________________________________
(Note: Use the overleaf or back page for extra entries)
G. List of Evidence That May Have Been Seized or Collected by the FR (If Any):
Description Disposition
________________________ ____________________________________
_________________________ ____________________________________
_________________________ ___________________________________
_________________________ ___________________________________
This further certifies that the Crime Scene and all the evidence therein by the FRs have
been properly secured and preserved and that all the information contained herein is true and
correct to the best of our ability:
_____________________________________ -- __________________________
_____________________________________ -- __________________________
Time/Date: _________________________________________________________
Witnessed By:
___________________________________________________________________
__________________________________________________________________
Rank/Name/Designation of Officer/
Signature over Printed Name