Taser Unintentional Disharge Injury Report 2007
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TASER® Unintentional Discharge/Injury Report NOTE: This form must be completed by the Master Instructor for ANY injury to instructors, students, or observers received during the conduct of a TASER International instructor course. Contact the TASER International Training Coordinator at 1-800-978-2737 and report the incident as soon as possible, then fax this report to 480-905-2034 Attention: Training Coordinator. Master Instructor Name: Date of Incident: Class Location: Name of Injured Party: Injury Occurred During (Circle One): Classroom Voluntary Exposure Firing Drills Scenarios Type of Injury: Specific Points of Probe Impact (If Applicable): Describe in detail how the injury happened. Please be as detailed as possible and use the back of this form if necessary: What treatment, if any was provided in class, or was any outside medical attention received: How can this type of injury be prevented in the future? List witnesses to the incident on the back of this form. TR-FORM-INCID-001 Rev: A June 1, 2007 Page: 1 of 1 © 1999–2007 TASER International, Inc. All Rights Reserved. The Globe & Lightning Bolt logo is a trademark of TASER International, Inc.