SUPERVISORY
TASER International USE REPORT
®

Subject’s
Name_______________________________________________Date/Time_______________
Location______________________________________________________Booked: Y / N
Where _____________________ Charges___________________________________________
Officer’s Name ___________________________________ Sgt. _________________________
Lt. _____________________________________________ AIR 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: Y / N
Admitted to Hospital for Psychiatric: Y / N
Medical Exam: Y / N
Suspect Under the influence: Drugs / Alcohol
Summary of the Actions of Officer(s) Involved: ____________________________________
Was an Officer, Police Employee, Volunteer or Citizen Injured? Y / N
Incident Type {Circle appropriate response(s) below}:
Civil Disturbance

Suicidal

Violent Suspect.

Barricade

Warrant Service.

Other.

TASER INTERNATIONAL LESSON PLAN p. 1

Age: _____ Sex: _____ Height: _____ Race: _____ Build: ( ) Heavy ( ) Med. ( ) Trim
Suspect wearing heaving clothes: Y / N
Actual TASER application: _____ Arc Display Only _____ Display Only _____
TASER: Is this a dart probe contact: Y / N. Is this a stun gun contact: Y / N
TASER® weapon used: ( ) AIR TASER 34000-series ( ) ADVANCED TASER M-series
Approximate target distance at the time of the dart launch:
____________________________________________________________________________
Need for an additional shot? Y / N
Did dart contacts penetrate the subject’s skin? Y / N
TASER: Did the application cause injury: Y / N. If yes, was the subject treated for the
injury: Y / N.
DESCRIPTION OF INJURY:
________________________________________________________________________________
________________________________________________________________________________
____________________________________________________________________
APPLICATION AREAS - Points of contact

SYNOPIS:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

TASER INTERNATIONAL LESSON PLAN p. 2

_______________________________________________________________________________________________
_____________________________________________________________________________

Need for additional applications? Y / N
Did the device respond satisfactorily? Y / N
Describe the subject’s demeanor after the device was used or displayed?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________

Was the subject under the influence of drugs or alcohol? (confirmed by)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________
Describe the danger present:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________
Describe other means attempted to control the subject: (If not used, explain)
Chemical Spray:
________________________________________________________________________________
________________________________________________________________________________
____________________________________________________________________
Baton or Blunt Instrument:
________________________________________________________________________________
________________________________________________________________________________
____________________________________________________________________
Authorized control holds:
________________________________________________________________________________
________________________________________________________________________________
____________________________________________________________________
Photographs Taken (yes) (no)
If not, explain:

TASER INTERNATIONAL LESSON PLAN p. 3

________________________________________________________________________________
________________________________________________________________________________
____________________________________________________________________
Fire Department Report # _______________________________________________
Report Completed by:
_______________________________________________
ADDITIONAL INFORMATION
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________

TASER INTERNATIONAL LESSON PLAN p. 4