TASER® X26 / M26 Volunteer Exposure Report
Age: _____ Sex: _____ Height: ______ Weight: ______ Check:
Did dart contacts penetrate the subject’s skin? Y / N
Length Of Exposure:
5+ Seconds;
5 Seconds;
4 Seconds;
Air Cartridge Type:
Regular Darts
XP Darts
Drive Stun:

M26

X26

3 Seconds;
2 Seconds;
Alligator Clips

1 Seconds

YES / NO 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 “X’s” on the points of contact

Please list how the TASER affected you:

__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________________
Could you fight the effects of the Taser and continued your attack?

__________________________________________________________________________________
________________________________________________________________
May we quote your comments? Y / N
Name/Rank:

________________________________ Signature: ________________________________________
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