Use Of Force Report Form
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1
2KUTZTOWN BOROUGH POLICE DEPARTMENT
Use of Force Report Form
Type of Offense:
Incident Log Number:
T y p e o f F o r c e r e p o r t i n g
(Circle those applicable)
USE OF FIREARM
Chemical Weapon Impact Physical
Other: (
)
Animal Destruction
Pointing
Accidental
Intentional
Date and Time of Incident:
Date and Time of Report:
L o c a t i o n o f I n c i d e n t
Street Address:
City:
State:
Zip Code:
Duty Status:
Attire:
:
Badge #
Rank:
Reporting Officer’s Full Name
(Circle one)
(Circle one)
On
/ Off
Uniform / Civilian
Involved Officer’s Full Name:
On
/ Off
Uniform / Civilian
On
/ Off
Uniform / Civilian
Verbal report made to:
Officer making verbal report:
Date and time verbal report made:
Witness Name:
Witness Address:
Witness Phone Number:
License Number:
Reason for Destruction:
Animal Type:
Owners Name
Owners Address:
Owners Phone Number:
Disposition of Animal:
P e r s o n / P r o p e r t y A f f e c t e d
(Circle one)
Officer
Bystander
Suspect
Property
Other (
)
Name:
Address:
City:
State & Zip Code:
DOB:
Age:
Male
Unknown
None
INJURY:
Arrest / Apprehended / Escaped
0
(Circle one)
Female
Wounded
Killed
Describe nature, extent and treatment of all injuries or property damage on Subject Compliance Supplemental Report Form:
Officer
Bystander
Suspect
Property
Other (
)
Name:
Address:
City:
State & Zip Code:
DOB:
Age:
Male
Unknown
None
INJURY:
Arrest / Apprehended / Escaped
Female
(Circle one)
Wounded
Killed
Describe nature, extent and treatment of all injuries or property damage on Subject Compliance Supplemental Report Form:
Combat information
Weather:
Lighting:
Combat distance:
Suspect motorized: Yes / No
Weapon used by Officer:
Serial #:
# of shots:
Weapon used by Officer:
Serial #:
# of shots:
Weapon used by Suspect:
Serial #:
# of shots:
Weapon used by Suspect:
Serial #:
# of shots:
Submit complete details of above information and narrative on a Subject Compliance Supplemental Report Form
Officer Signature/Badge No.:
Supervisor Signature/Badge No.:
KPD SCRF 06/01
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