ADVANCED TASER USAGE REPORT
Or Number:
Date of the incident:
Location of the Incident:
Subjects Name: Last:
Call Type:

Fire DR#
Time of incident:
Inside Outside Open Area Enclosed Area Vehicle
First:
Photographs Taken:
Yes No

Supervisors: Sgt:
Lt:
Report Completed By:
Serial Number of Device:
Serial Number of probe cartridge if expended:
Officers Involved:
Primary_______________________________Support__________________________________
Support_______________________________Support__________________________________
APPLICATION INFORMATION
Advanced Taser Probe Contact: Yes No
Touch Stun Gun Contact:
Number of times Taser Display Only
______
Number of Touch Stuns
______
Number of times Applied (Probe Contact) ______
Number of activations after probe contact ______
Type of Force used prior to taser: None
Type of Force Used After Taser: None

Low Level
Low Level

Intermediate
Intermidiate

Yes No

High
High

Approximate Target Distance at the time of dart Launch:
Did the taser gain subjects complience: Yes No Need for Additional Shot: Yes No
Did the dart contacts penetrate the subjects skin: Yes No
Type
of Force
used
after
Low Level
High
Was the
subject
under
thetaser:
influence None
of: Drugs
AlcoholIntermediate
Subject’s demeanor after taser was used or displayed: Cooperative Belligerent Combative
Abusive Aggressive Complaining
MEDICAL INFORMATION
Was an Officer, Police Employee or Citizen injured:
Yes

No

Nature of injury and Medical Treatment Required other than normal injury caused by
taser darts:
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APPLICATION AREAS-POINTS OF CONTACT
(One for each dart)

Face

Head

Neck
Neck
RS

LS

LS

RS

Chest
R Arm

Up Bck

L Arm
Abdom

L Arm

R Arm
L Bck

Groin

LH

RH
Butt
R Thi

L Thi

LH

RH
L Thi

R Leg

L Leg
L Leg

RF

R Thi

R Leg

LF
LF

RF

SYNOPSIS OF INCIDENT
What happened, any present dangers, other restraint /compliance methods etc.
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