If you receive a bomb threat, it is important to be prepared and have a plan in place. This Bomb Threat Checklist Form can help you do just that. By having this form handy, you can ensure that you collect all of the necessary information to help keep yourself and others safe. Print out a copy of this form and keep it in a safe place so that you are ready for any potential threats.
| Question | Answer |
|---|---|
| Form Name | Bomb Threat Checklist Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Homeland Security Bomb Threat Checklist Form, Telephone Bomb Threat Checklist Form |
BOMB THREAT CHECKLIST
TIME: ____________ DATE: __________________
EXACT WORDING OF THREAT:
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
IMPORTANT QUESTIONS TO ASK:
1. When is the bomb going to explode?
______________________________________
2. Where is the bomb right now?
______________________________________
3. What does the bomb look like?
______________________________________
4. What kind of bomb is it?
______________________________________
5. What will cause the bomb to explode?
______________________________________
6. Did you place the bomb?
______________________________________
7. Why?
______________________________________
8. What is your address?
______________________________________
9. What is your name?
______________________________________
CHARACTERISTICS:
Gender: ________ Age: ________ Race: ________
|
CALLER’S VOICE |
|
|
□ Calm |
□ Nasal |
□ Soft |
□ Angry |
□ Stutter |
□ Loud |
□ Excited |
□ Lisp |
□ Laughter |
□ Slow |
□ Rasp |
□ Crying |
□ Rapid |
□ Deep |
□ Normal |
□ Distinct |
□ Slurred |
□ Whispered |
□ Ragged |
|
□ Disguised |
□ Accent |
□ Clearing Throat |
|
□ Deep Breathing |
□ Cracking Voice |
||
□Familiar (If voice is familiar, who did it sound like?)
____________________________________________
BACKGROUND SOUNDS:
□ Street noises |
□ Factory machinery |
□ Voices |
□ Crockery |
□ Animal noises |
□ Clear |
□ PA System |
□ Static |
□ Music |
□ House noises |
□ Long distance |
□ Local |
□ Motor |
□ Office machinery |
□ Booth |
□ Plane |
□ Other (Please specify) |
|
____________________________________________
BOMB THREAT LANGUAGE:
□ Well spoken (education) |
□ Foul |
|
□ Incoherent |
□ Irrational |
□ Rambling |
□Message read □ Taped message
REMARKS: __________________________________
_____________________________________________
_____________________________________________
CALL DETAILS:
Telephone number at which call was received:
_________________________
Telephone number from which call was made:
_________________________
Time call received: _______________________
Time call ended: _________________________
Your Name: _________________________________
Your Position: _______________________________
Your Department: ____________________________
Your Telephone Number: ______________________
Your
Date Checklist completed: _____________________