Blue Alert Request Form
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2TEXAS DEPARTMENT OF PUBLIC SAFETY
BLUE ALERT REQUEST FORM
Fax (512) 424-2281 or (512) 451-2291; and Call (512) 424-2277 or 2208
MAXIMUM ACTIVATION - 24 HOURS
Requesting Agency Information
Activation Criteria:
*Required Fields in red with an asterisk
1. A law enforcement officer must have been killed or seriously injured by
□
□
an offender?
INITIAL
UPDATE
□
□
*
Request
YES
NO
2. The investigating law enforcement agency must determine that the
*
Date of Request
offender poses a serious risk or threat to the public and other law
enforcement personnel?
□
□
*
Name of Reporting Agency
YES
NO
*
Contact number for Reporting Agency
3. A detailed description of the offender’s vehicle, vehicle tag, or partial
tag must be available for broadcast to the public?
□
□
YES
NO
*
Fax number for Reporting Agency
4. The investigating law enforcement agency of jurisdiction must
recommend activation of the Blue Alert to the State Operations
*
Name/Title of Investigating Officer
Center (Texas Division of Emergency Management )?
□
□
YES
NO
*
Cell phone number for Investigating Officer
*
Phone number for media inquiries
IMPORTANT: Do NOT send the BLUE ALERT request if the answer is NO to ANY of these questions. If activated, the
request is only valid for a period of 24 hours. You will be contacted after 12 hours, 18 hours, and 23 hours in which you may
decide to request an extension. All requests for extension must be accomplished on or before the last 23 hour reminder from the
State Operations Center. Contact (512) 424-2277 or 2208 for all requests for extensions.
Incident Date:
Time:
Incident Location:
INJURED/DECEASED OFFICER DATA:
Name:
Rank/Title:
*Check Which One Applies:
Injured
Deceased
Agency:
Nature of Injury (If Injured):
Check Which One Applies:
Local LEO
State LEO
Federal LEO
SUSPECT DATA
Name (If Known):
Last Known Location of Suspect/Offender:
Age:
DOB:
Weight:
Height:
Eyes:
Hair:
Sex:
Race:
Clothing Description:
Unique Physical Characteristics:
VEHICLE DATA
Make:
Model:
Year:
Color:
LP-State:
LP-Number:
Any other descriptors:
TDEM-52 (Rev. 06/2015)
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