ADVANCED TASER® DEMO REPORT
Date ____________ Officer’s Name with rank: ______________________________
Department: ____________________________
Age: _____ Sex: _____ Height: _____

Build: ( ) Heavy ( ) Med. ( ) Trim

Did dart contacts penetrate the subject’s skin? Y / N
Regarding the ADVANCED TASER: Did the application cause injury: Y / N.
If yes, was the subject treated for the injury: Y / N.
Please place and "X" over the area where the applications was applied.
APPLICATION AREAS - Points of contact

Please list effects, comments and or how it felt. (Note, could you fight back?):
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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This information is requested for the International Association of Chiefs of Police Use of Force
National Database Project and published in our medical research.
May we quote your comments
Signature: ________________________________________