Form Sp-323 - Officer-Involved Shooting Form
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1SP-323 (07-01-2016)
OFFICER-INVOLVED SHOOTING
Incident Number:
Agency Name:
Agency ORI Number:
Agency/Division Head:
County/City:
Pursuant to §52-28.2 in the Code of Virginia enacted on July 1, 2016, the Department of State Police shall include any officer involved
shootings and whether they were determined to be justified will be enumerated in the Crime in Virginia publication.
1. Did this officer-involved shooting result in death of the criminal?
YES
NO
1a. Was this officer-involved shooting determined to be justified?
YES
NO
DATE OF INCIDENT
(mm/dd/yyyy)
2. Did this officer-involved shooting result in serious bodily injury of the criminal?
YES
NO
2a. Was this officer-involved shooting determined to be justified?
YES
NO
DATE OF INCIDENT
(mm/dd/yyyy)
3. What agency conducted the investigation of this incident?
NAME OF AGENCY_______________________________________________
ORI (IBR): ___________________
Prepared by: ___________________________
Title: _________________________
Date:
Telephone Number: _______________________
(mm/dd/yyyy)
INSTRUCTIONS & DEFINITIONS
This form is to be used to report officer involved shootings using the following definitions.
•
Officer-Involved Shooting: For the purposes of this form, Officer Involved Shooting means the discharge of a firearm by a
law-enforcement officer, as defined in §9.1-101, that results in the death or serious bodily injury of another.
•
Serious Bodily Injury: “Bodily injury that involves a substantial risk of death, unconsciousness, extreme physical pain,
protracted and obvious disfigurement, or protracted loss or impairment of the function of a bodily member, organ, or mental
faculty. 18 U.S. Code § 2246.”
Please send completed forms:
U. S. Mail
Email
Fax
Virginia State Police
804-674-2918
UCR/IBR Section
Officer-InvolvedShooting@vsp.virginia.gov
P.O. Box 27472
Richmond, Virginia 23261-7472
Questions regarding this form should be directed to the UCR/IBR Section: (804) 674-2143.
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