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

Clear
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