SUPERVISORY
ADANCED TASER USE REPORT
Subject’s Name:

Report Date:

Location:

Booked:
Charges:

Officer’s Name:

Sgt.:

Lt.:

ADV. TASER Serial #:

Medical Facility:

Doctor:

OR#::

Fire DR#::

Date of the Incident:

Time of Incident:

Location of the Incident:
Officer(s) Involved:
Nature of the Call
or Incident:
Type of Force Used (Check all that apply):

Physical

Less-lethal

Firearm

Nature of the Injuries and Medical Treatment Required:
Admitted to Hospital for Injuries:
Admitted to Hospital for Psychiatric:
Medical Exam:

Summary of the Actions of Officer(s) Involved:

Was an Officer, Police Employee, Volunteer or Citizen Injured?:
Incident Type [check appropriate response(s) below]
Civil Disturbance

Violent Suspect

Warrant Service

Suicidal

Barricade

Other

AIR TASER Incident Report

6/4/2009

Age:
Height:
Build:

Heavy

Sex:
Race:

Medium

Trim

Suspect wearing heaving clothes:
ADV. TASER Application:

Actual Use

Arc Display Only

ADV. TASER Use Mode:

Dart Probe Contact

Display Only

Touch Stun Contact

Approximate target distance at the time of the dart launch:
Need for an additional shot?:
Did dart contacts penetrate the subject’s skin?:

Regarding the ADV. TASER:
Did the application cause injury:
If yes, was the subject treated for the injury?:
DESCRIPTION OF INJURY:

APPLICATION AREAS - Points of contact

Head

Face

Neck

Neck
RS

LS

LS

RS
Up Back

Chest
R Arm

L Arm

L Arm

Abdom

RH

Groin

R Arm
Low Back

Buttocks

LH
RH

LH

R Thi

L Thi

L Thi

R Thi

R Leg

L Leg

L Leg

R Leg

RF

LF

AIR TASER Incident Report

LF

RF

6/4/2009

SYNOPIS:

Need for additional applications?:
Did the device respond satisfactorily?:
Describe the subject’s demeanor after the device was used or displayed?

Suspect Under the influence:
Confirmed by:

Describe the danger present:

Describe other means attempted to control the subject: (If not used, explain)
Chemical Spray Used?:
Explanation:

Baton or Blunt Instrument?:
Explanation:

Authorized control holds?:

Photographs Taken?:
If not, explain:

Report Completed by:

X ________________________
Signature (Hard Copy)

ADDITIONAL INFORMATION

AIR TASER Incident Report

6/4/2009

INSTRUCTIONS:
1. Save this file to your hard drive. It will not email properly until after being saved.
2. Submit this report to the national ADVANCED TASER incident database.

Email to: Jami@taser.com
Click "File" -> "Send" -> "Mail Recipient" (send to: Jami@TASER.com)
This information will be submitted to the International Chiefs of Police Association to track use of force.
3. If you cannot email, please fax a copy of this report to: (480) 991-0791 Attn: Jami Hill (PH: 800-978-2737 ext. 2016)
4. Save a copy of this report to your department archives.
5. Print and sign a copy of this report and deliver to supervising officer for filing in department records.

AIR TASER Incident Report

6/4/2009