Wisconsin Fusion Center


Suspicious Activity Reporting
Important: If this is an emergency - Call 911

Submitter's First Name:*

Submitter's Last Name:*

Agency / Organization Name:

Best Contact Number: (###) ###-#### *

Email Address: *


Incident Date:(mm/dd/yyyy) 
  Time:    (e.g. 10 pm) 

Brief summary: *


Name of Subject(s):(If available)  

Subject Identification: (DOB; Drivers License #; Phone Numbers)

Incident Location - Street Address or Cross Streets: *

City:*

State:*



Optional Information

Secondary Contact Name:(if applicable)

Alternate Contact Number:(###) ###-####  (if applicable)

Alternate Email Address:(if applicable)