Use of Force Report

Use of Force Report
Report Filled by*

First NameMiddle NameLast NameLAST 4 of SSN
Reporting employees relationship to incident is:*

An employee involved in the use of forceSupervisor taking a use of forces report post incident.A witness to the use of forceSupervisor investigating use of force report at a later time.
Date of Report*

MonthDayYear
Date
Hour MinutesAM/PM Option
Approximate date of Incident*

MonthDayYear
Date
Hour MinutesAM/PM Option
Location of Incident*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Subject's Name*

First NameMiddle NameLast NameSuffix
Subject's Height * Subject's Phone *
Subject's Weight *Subject's Eye Color*
Subject's Hair Color *
Subjects Date of Birth

MonthDayYear
Date
Why was force used:*

to affect an arrestto defend another officer / personto defend selfprotective custody / subject safetyprevent escapeOther
List the most serious offenses committed at the time offence was committed:*
Was the subject injured? (Describe in detail in the incident narrative.)*

YesNo
Was an employee injured? (Describe in detail in the incident narrative.)*

YesNo
Was medical treatment required or provided? (Describe in detail in the incident narrative.)*

YesNo
List any subjects that resisted*
List all employees present*
List the supervisor who was notified, by whom they were notified, and time they were notified. *
At the time of the arrest, the subject was:*

Suspected to be under influence of alcohol or drugsMentally impaired or emotionally disturbedKnown to be under the influence of alcohol or drugsN / AOther
Officers perception of individual(s) actions. Use narrative to describe percieved threat(s) posted by individual:*

Passive Resistance - Dead weight or non-compliance to employees lawful verbal direction, but while offering no actively resistive movement.Active or Escape Resistance - Actions such as pushing, pulling, evasive arm movement, flailing, flight, muscle tension, etc to avoid control. (Does not include attempt to harm the officer.)Assaultive - High Risk - Agitated, combative state, physically assaultive actions and / or behavior that poses threat of injury to another. (E.G. punching, kicking, clenching of fists)Life Threatening / Serious Bodily Injury - Actions that may result in death or serious injury.
Officer's response option(s) (Provide further details in incident detail summary below)
What was the presence of the employee. Employee's not in full uniform describe the means of visual identification (vests, jacket, displayed badge or ID markings in the incident detail summary.*

Full uniform, with exposed patches and / or badgePartial uniform, with exposed patches and /or badgePlainclothes - Business AttirePlainclothes
Were verbal commands used*

YesNo
Were compliance techniques used - Force used to gain control - restraint, come-along, takedown - use of hands, arms, feet. (Describe in the incident detail summary below)*

YesNo
Were chemical agents / chemical spray used*

YesNo
IF CHEMICAL AGENTS USED:
Number of bursts: Duration of bursts:
Distance from subject: Impact Location:
time between contamination and decontamination:
Were impact weapons used. (Describe in detail in the incident narrative.)*

YesNo
Were Electronic Control Devises used: (Describe in detail in the incident narrative.)*

YesNo
If yes, describe the ECD / CEW/ "Taser" usage:

Laser OnlySpark Check / Audible SparkDrive Stun / Contact StunProbe Deployment
IF PROBES WERE USED:
Probe impact site:
Number of cycles:
Was a firearm pointed or drawn: (Describe in detail in the incident narrative.)*

YesNo
Were any weapons drawn lethal or Less Than Lethal: (Describe in detail in the incident narrative.)*

YesNo
Was deadly force used: (Describe in detail in the incident narrative.)*

YesNo
Additional force options that were used: (Describe in detail in the incident narrative.)
Was a restraint method used: (Describe in detail in the incident narrative.)*

N / A - Subject was not restrainedHandcuffsFlex cuffsProbe DeploymentPhysical restraintOther
Other persons present that witnessed scene. *
Is there video or audio evidence of incident: (Describe in detail in the incident narrative.)*

YesNo