Form Builder

Required fields are marked with asterisks (*)

Online Reporting Gas Drive Off

If this is an incident that is "in-progress", please call 519-824-1212 ext. 0 to speak to a dispatcher OR dial 911 if it is urgent.

Organization (victim)

Name of Organization:

Address:

Main phone number:

Complainant (eg. Clerk)

Name:

Date of Birth:

Address:

Contact number:

Email address:

Incident

Date of Incident:

Time of Incident:

Narrative: Please provide a description of what the suspect(s) did. You will be asked a description of the suspects next, so please refer to them as Suspect 1, Suspect 2, etc.

For example, on March 1, 2024, at 4:30pm, I saw a red Ford F150 pull in to pump 4. One guy got out and pumped $163.21 worth of gas. I could see him put his credit card in the pump computer, but it didn’t work. He then took off.

Narrative:

Suspect Description(s): Please provide a detailed description of any suspects. Include approximate age, height, weight, body type, hair colour, gender appearance, clothing description. For example:

Suspect 1: 5’9”, 150lbs, medium build, blond hair, male, 30 years, black hoodie, black jeans, white running shoes.

Suspect 2: 5’2”, 100lbs, thin build, blond hair, female, 20 years, white hoodie, blue jeans, black shoes.

Suspect Description(s):

Vehicle Involved

Make: (U/K is unknown)

Model: (U/K is unknown)

Approximate year (if not known, "older", "newer")

License Plate:

Last known Direction of Travel:

How Much Fuel Taken

How Much Fuel Taken:

Is there video available: (if yes, an officer will send a link to the provided email address to upload video)

Yes

Is there anything you would like to add that may be relevant to the incident?