TASER® M26/X26 Volunteer
Exposure Report
Age:

Sex:

Height:

Weight:

Check: 

M26 

X26

Did dart contacts penetrate the subject’s skin? Yes  No
Length Of Exposure:
5+ seconds; 

5 seconds; 

TASER Cartridge type: 

4 seconds; 

Regular Darts 

3 seconds; 

XP Darts 

2 seconds; 

1 second

Alligator Clips

Drive-Stun:  Yes  No  (If Yes, length of exposure):
Did the application cause injury:  Yes  No  (If yes, advise the instructor and complete the Injury
Report)
If yes, was the subject treated for the injury:  Yes  No
APPLICATION AREAS: Please place “Xs” on the points of contact

Please describe how the TASER device affected you:

Could you have fought the effects of the TASER device and continued your attack?

May we quote your comments?  Yes  No
Name/Rank:
Signature:

TR-FORM-VERPT-001 Rev: A
June 1, 2007
Page: 1 of 1
© 2007 TASER International, Inc. TASER®, Shaped Pulse™, and the Globe & Lightning Bolt Logo are trademarks of TASER International, Inc.