COTATI POLICE DEPARTMENT

ROBERT STEWART, CHIEF OF POLICE

201 WEST SIERRA AVENUE • COTATI, CA 94931 • PHONE: (707) 792-4611 • FAX: (707) 795-0168

TASER USE REPORT
08/30/07
02-1481
N/A
Date/Time: _________________
CR #: ________________
Fire/Med. Incident #: ________________
jburns@ci.cotati.ca.us
J. Burns #325
E-mail: _________________________
TASER Officer’s Name: ________________________________

201 W. Sierra Ave., Cotati CA 94931
(707) 792-4611
Department Address: ________________________________________
Phone: ____________________
Sgt. Petersen
Dorsaneo #312
On Scene Supervisor: ___________________Officer(s)
Involved: _______________________________
P001358
N/A
N/A
TASER Serial #: _____________
Medical Facility: _________________
Doctor: _________________

Warrant Service
11377(a) H&S
Yes
Nature of the Call or Incident: ___________________
Charges: __________________
Booked: _____
Location of Incident: ✘ Indoor

Outdoor

Type of Force Used (Check all that apply):

Jail

Hospital _______________________________

Physical

✘ Less-lethal

Firearm

N/A
Nature of the Injuries and Medical Treatment Required: ______________________________________

No
Admitted to Hospital for Injuries: ______
No
Medical Exam: ______

No
Admitted to Psychiatric Emergency Services: ________

N/A
Suspect Under the Influence: Alcohol / Drugs (specify): __________________

No
Was an Officer, Police Employee, Volunteer or Citizen Injured? ______
Warrant Service
Incident Type: ______________________________

30
6-03
B
280
M
SUBJECT – Age: ________
Sex: ________
Height: ________
Race: ________
Weight: ________

Success
TASER Use: _______________

Suspect wearing heavy clothes: _______

Number of Air Cartridges fired: _________

0
Number of cycles applied: ___________

Laser Display Only
Type of Usage: ______________________________

No
TASER: Is this a dart probe contact: ________

No
Is this a stun gun contact: ________

TASER® weapon used: M - 2 6 A D V A N C E D T A S E R

N/A
Approximate target distance at the time of the dart launch: __________________________________

N/A
Distance between the two probes: ________________
Need for an additional shot? ________
Did dart contacts penetrate the subject’s skin? _______
TASER: Did the application cause injury: ____

Probes removed on scene: _______

If yes, was the subject treated for the injury: ____

DESCRIPTION OF INJURY:

N/A
APPLICATION AREAS - Points of contact (place “X’s” where probes hit suspect)

SYNOPSIS:

Deployed laser at suspect, suspect surrendered.

No
Need for additional applications? ________

Yes
Did the device respond satisfactorily? ________

Describe the subject’s demeanor after the device was used or displayed?

Cooperative

No
Chemical Spray: _______

No
Baton: _______

No
Authorized control holds: _______

No
Blunt Instrument: _______

If yes, what types: ______________________________________

Describe other means attempted to control the subject: _______________________________________

No
Photographs Taken: _______

J. Burns #325
Report Completed by: __________________________________
ADDITIONAL INFORMATION

CPD #02-002 (Rev. 05/02)