Surveillance Video Request Form

Use this form to request video clips from the district surveillance system. Clips must be requested no later than 7 days from the incident, 24 to 48 hours after the incident would be best. Please keep the time frame as narrow as possible to make clips quicker to obtain and avoid loss. Video requests are only accepted from and provided to building and district administration. If you are a parent or community member, please request this through the school principal.
Your email will be recorded when you submit this form.
Please be as detailed as possible the more detail the better the chance we will find the footage.
* Required

Media
Serial Number (Office Use Only)
School / Building

Choose your location from the drop down list.
Name Name First Last
The person requesting video.
Incident Reporting (What Happened)
Date of Incident / Clip Requested use a new form for each date change. Date of Incident / Clip Requested use a new form for each date change. / MM / DD YYYY
1st Camera

You can add 1 or up to 3 cameras per form. Please use the camera number or name.
1st Camera Number
Cam1 Start Time Cam1 Start Time : HH MM AM/PM
End Time End Time : HH MM AM/PM
2nd Camera Number
Cam2 Start Time Cam2 Start Time : HH MM AM/PM
End Time End Time : HH MM AM/PM
3rd Camera Number
Cam 3 Start Time Cam 3 Start Time : HH MM AM/PM
End Time End Time : HH MM AM/PM
Has your Principal been notified of this request? All requests require Principal notification.

Has your Principal been notified of this request? All requests require Principal notification. YES NO
Will CD(s) / DVD Copies be required?
(Note no CD's will be made and or distributed to anyone not authorized by the School City of Hammond. No parents are allowed to obtain copies of any incidents captured on the SCH surveillance system.)

Will CD(s) / DVD Copies be required?
(Note no CD's will be made and or distributed to anyone not authorized by the School City of Hammond. No parents are allowed to obtain copies of any incidents captured on the SCH surveillance system.) YES NO
How any copies are you requesting? (Copies will not be made unless approval has been issued.)

How any copies are you requesting? (Copies will not be made unless approval has been issued.) 1 CD/DVD 2 CD's/DVD's 3 CD's/DVD's
Please use another form if over 3 cameras are needed. All items must be filled in completely

Surveillance Video Request Form

Surveillance Video Request Form

Media

1st Camera

Please use another form if over 3 cameras are needed. All items must be filled in completely