Use of Force Form

Use of Force Report

Arcanum Police Department
Case #
Incident Report #*
1. Nature of Call*
2. Location of Call*
3. Subjects Name*
DOB*
SSN*
4. Type of Response Used

FirearmFirearm DisplayConducted Energy WeaponTaser Display OnlyChemical AgentBatonOther
5. Reason for Response

ArrestDefenseDetainOther
Injury to Subject

YesNo
Photos Taken of Injury

YesNo
Nature to Injury
Treatment by:

Medic/SquadHospitalPhysicianOther
Transported By
Subject refused transport

Refused
Injury to Officer

YesNo
Nature of Injury
Treatment by:

Medic/SquadHospitalPhysicianOther
Transported By
Officer refused transport

Refused
8. At time of incident, was subject suspected of being under

Mental Stress / InstabilityInfluence of Alcohol/DrugsNone
1 Officer
Unit
2 Officer
Unit
3 Officer
Unit
4 Officer
Unit
5 Officer
Unit
Level of Resistance (Check all that Apply

Weapon Used Against OfficerAttempting to Disarm OfficerLife-Threating/Weaponless AssaultsStriking or Kicking OfficerWrestling with OfficerPushing OfficerPulling Away from OfficerRefusing to Move/Dead WeightNot Responding to CommandsHigh Risk/Unknown Treat/Felony StopOther
Level of Control (Check all that Apply)

Display of FirearmHobble/Leg RestraintsTaser Display OnlyConducted Energy Weapon ApplicationChemical AgentBaton/ASP Flashlight TechniquesStriking Motor Points or MuscleJoint Manipulations PPC Grounding Techniques Empty hand controlBalance Displacement Escort PositionAssistance from Officers - K-9Deadly Force
Note: Not a Column to Column Correlations (Check all that Apply)
10. List Witnesses
Submitting Officer's Signature
Date

MonthDayYear
Date
Hour Minutes
Reviewed By

Appropriate Response to ResistanceCritical Incident Debriefing RequiredFollow-Up RequiredDisciplinary Proceedings InitiatedYesNo
Reviewed By
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Use of Force Report