KUTZTOWN 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)
Chemical Weapon Impact Physical
Other: (
)
Date and Time of Incident:
USE OF FIREARM
Animal Destruction Pointing Accidental
Intentional
Date and Time of Report:
Location of Incident
Street Address:
City:
Reporting Officer’s Full Name:
State:
Badge #
Rank:
Zip Code:
Duty Status:
Attire:
(Circle one)
(Circle one)
On
/ Off
Uniform / Civilian
On
/ Off
Uniform / Civilian
On
/ Off
Uniform / Civilian
Animals
Involved Officer’s Full Name:
Verbal report made to:
Officer making verbal report:
Date and time verbal report made:
Witness Name:
Witness Address:
Witness Phone Number:
Animal Type:
License Number:
Reason for Destruction:
Owners Name
Owners Address:
Owners Phone Number:
Disposition of Animal:
Person/Property Affected
Officer
Bystander
Name:
Suspect
Property
Other (
Address:
DOB:
Age:
0
Male
Female
(Circle one)
)
City:
Arrest / Apprehended / Escaped
State & Zip Code:
INJURY:
(Circle one)
Unknown
Wounded
None
Killed
Describe nature, extent and treatment of all injuries or property damage on Subject Compliance Supplemental Report Form:
Officer
Bystander
Name:
Suspect
Property
Other (
Address:
DOB:
Age:
Male
Female
)
City:
Arrest / Apprehended / Escaped
State & Zip Code:
INJURY:
(Circle one)
Unknown
Wounded
None
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
KUTZTOWN BOROUGH POLICE DEPARTMENT
Subject Compliance Supplemental Report Form
PAGE: _____ OF _____
Incident Log Number:
Date and Time of Incident:
Date and Time of Report:
Location of Incident
Street Address:
City:
Reporting Officer’s Full Name:
Badge #
State:
Rank:
Zip Code:
Duty Status:
Attire:
(Circle one)
(Circle one)
On
/ Off
Uniform / Civilian
DESCRIBE IN DETAIL: The nature of the enforcement action; the reason for the force used; including the actions and
demeanor of the arrestee; presence of others [police officers, possible friends of the subject, disinterested witnesses,
etc.]; and other types of force that were considered.
Continuation of Subject Compliance Report Form and Narrative
For continuation complete additional Subject Compliance Supplemental Report Forms
Officer Signature/Badge No.:
Supervisor Signature/Badge No.:
KPD SCSRF 06/01
SUBMIT TO CHIEF