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