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2. Use of Force Documentation
4. ICR #*
5. Date/Time of Incident
   Date/Time of Incident

   Date/Time of Incident
7. Suspect Name and DOB (First, Middle, Last)*
9. Race*

   1. White
   2. Black
   3. American Indian
   4. Hispanic
   5. Asian
   6. Unsure
   7. Native Hawaiian
10. Age*

    1. Adult
    2. Juvenile
11. Gender*

    1. Male
    2. Female
    3. Other
13. Big Lake Resident? *

    1. Yes
    2. No
14. Location Type*
    -- Select One --Street/RoadwayResidence Apartment - Hallway/Common AreaParking LotBusiness Establishment (bar, restaurant, retail)Big Lake SchoolsCity PropertyOther
15. Reason for Initial Contact*
    -- Select One --Traffic Stop / Suspicious VehicleSuspicious Person / Pedestrian StopDisturbance Violation of Court OrderDomesticMedical/Mental Health Welfare CheckWarrant Assist for SchoolOther
17. Officer's Perception of Individual's Actions

    1. Psychological Intimidation (Pre-Fight Indicators)
    2. Verbal Non-Compliance (Statements, Arguing)
    3. Passive Resistance (Dead weight or non-compliance to Officer's lawful verbal direction, but offering no actively resistive movement)
    4. Defensive Resistance (Actions such as pushing, pulling, evasive arm movement, flailing, flight, muscle tension, etc. to avoid control)
    5. Active Aggression (Agitated, combative state, physically assaultive actions and/or behavior that poses threat of injury to another, such as: punching, kicking, clenching fists, etc.)
    6. Deadly Force Assault (Actions that may result in death or great bodily harm)
19. Type of Force Used (check all that apply)*

    1. Verbal Commands
    2. Compliance Techniques (Force used to gain control - restraint, escort, takedowns)
    3. OC Spray Deployment
    4. PepperBall Area Saturation
    5. TASER Deployment
    6. Direct Impact with PepperBall
    7. Hard Empty Hand Control (Strikes, Kicks)
    8. Less Lethal Deployment (Pepperball, Bean bag)
    9. Property Damage (Breaking Glass, Door Jams)
    10. K-9 Apprehension
    11. Point a Firearm
    12. Discharge of Firearm
    13. Deadly Force Employed
    14. Pursuit Intervention Tactic
    15. Up Armor Vehicle Response
    16. Other
20. If Other, What Technique Used?
22. Was Medical Attention Needed?*

    1. Yes
    2. No
23. If Yes, What Were the Injuries? Who treated/Where?
25. Officer(s) Present During Incident (check all that apply)*

    1. Chief John Kaczmarek
    2. Captain Sam Olson
    3. Investigator Tom Kucala
    4. Investigator Silas Reek
    5. Officer Chris Hoard
    6. Sergeant Sam Norlin
    7. Sergeant Guy Chaffee
    8. Officer Tyler Hecht
    9. Officer Nic Prigge
    10. Officer Joe Kalla
    11. Officer Chris Thull
    12. Officer Jennifer Franzen
    13. Officer Bill Saliterman
    14. Officer Michael Kern
    15. Officer Kiana Shafranski
    16. School Resource Officer
    17. Officer/Deputy/Trooper From Other Agency
26. Weapons Used by Subject (check all that apply)*

    1. Knife
    2. Improvised Weapon (screw driver, hammer, etc)
    3. Brass Knuckles
    4. Gun (handgun/long gun)
    5. Vehicle
    6. Body Weapons (fist/kick)
    7. None
    8. Other
27. If Other, What Was Used?
29. Was the Suspect Perceived to be Under the Influence of Drugs or Alcohol?*
    -- Select One --Yes - DrugsYes - AlcoholYes - Both No Unknown
30. Were officers injured?*

    1. Yes
    2. No
31. If Yes, What were the injuries? Who treated/where?
33. Does the Suspect have any Known Medical or Mental Conditions?*

    1. Yes
    2. No
    3. Unknown
34. If Yes, What Are They?
36. Was the Suspect Arrested?*

    1. Yes
    2. No
37. If No, Why? If Yes, What Charges?
39. Officer Filling Out the Form*
    -- Select One --Chief John KaczmarekCaptain Sam OlsonInvestigator Tom Kucala Officer Nic PriggeOfficer Chris HoardSergeant Sam NorlinSergeant Guy ChaffeeOfficer Tyler HechtInvestigator Silas ReekOfficer Joe KallaOfficer Jennifer FranzenOfficer Chris ThullOfficer Bill SalitermanOfficer Michael KernOfficer Kiana Shafranski
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