Form 1-705 - Law Enforcement Officers Killed Or Assaulted

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1-705 (Rev. 08-01-2000) (Jan2012)

Form

OMB No. 1110-0006

LAW ENFORCEMENT OFFICERS KILLED OR ASSAULTED

Please electronically submit this to BCI by checking "Submit Form" when completed. This form should be used to report the number of your officers who were killed or

assaulted in the line of duty during the month. Additional information on officers who were killed or assaulted and injured with a firearm or a knife or other cutting

instrument will be requested on a separate questionnaire, Analysis of Law Enforcement Officers Killed or Assaulted .

OFFICERS KILLED

Number of your law enforcement officers

By felonious act:

killed in the line of duty this month.

By accident or negligence:

Officers Assaulted (Do not include officers killed) - See page 2 for instructions.

Type of Weapon

Type of Assignment

Detective or special

One-officer vehicle

assignment

Other

Alone

Assisted

Alone

Assisted

Alone

Assisted

Type of Activity

Responding to disturbance calls (family

quarrels, person with firearm, etc.)

Burglaries in progress or pursuing burglary

prospects

Robberies in progress or pursuing robbery

prospects

4 Attempting other arrests

5 Civil disorder (riot, mass disobedience, etc.)

6 Handling, transporting, custody of prisoners

Investigating suspicious persons or

circumstances

8 Ambush - no warning

9 Mentally deranged

10 Traffic pursuits and stops

11 All Other

12 TOTAL (1 - 11)

Number with personal injury*

DO NOT WRITE HERE

Initials

Number without personal injury

Recorded

12:00 to

2:00 to

4:00 to

6:00 to

8:00 to

10:00 to

Edited

15 Time of assaults

2:00

4:00

6:00

8:00

10:00

12:00

Punched

Verified

Adjusted

Month

Year

Agency ORI

Prepared by

UTAH

Agency

State

Chief, Sheriff, Commissioner, Superintendent

* If the officer was injured with a firearm (13B) or a knife or other cutting instrument (13C), please complete the block on the second page side and include your agency's

incident or case number(s). This information is only for your agency's use to assist in referencing the incident once the above-mentioned questionnaire is forwarded to you

for completion.