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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. Gender*

   1. Male
   2. Female
   3. Other
10. Race*

    1. Caucasian
    2. African American
    3. Native American
    4. Hispanic
    5. Asian
    6. Unsure
11. Big lake Resident? *

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

    1. Passive Resistance (Dead weight or non-compliance to Officer's lawful verbal direction, but offering no actively resistive movement)
    2. Active or Escape Resistance (Actions such as pushing, pulling, evasive arm movement, flailing, flight, muscle tension, etc. to avoid control)
    3. Assaultive/High Risk (Agitated, combative state, physically assaultive actions and/or behavior that poses threat of injury to another, such as: punching, kicking, clenching fists, etc.)
    4. Life Threatening/Serious Bodily Injury (Actions that may result in death or serious bodily injury)
17. Type of Force Used (check all that apply)*

    1. Verbal Commands
    2. Compliance Techniques (Force used to gain control - restraint, escort, takedowns, use of hands, arms, legs, feet)
    3. OC Spray Deployment
    4. TASER Deployment
    5. Less Lethal Deployment (Pepperball, Bean bag)
    6. Property Damage (Breaking Glass, Door Jams)
    7. K-9 Apprehension
    8. Point a Firearm
    9. Deadly Force Employed
    10. Pursuit Intervention Tactic
    11. Other
18. If Other, What?
20. Was Medical Attention Needed?*

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

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

    1. Knife
    2. Tool (screw driver, hammer, etc)
    3. Brass Knuckles
    4. Gun (handgun/long gun)
    5. Vehicle
    6. None
    7. Other
25. If Other, What Was Used?
27. Was the Suspect Under the Influence of Drugs or Alcohol?*
    -- Select One --Yes - DrugsYes - AlcoholYes - Both No Unknown
28. Were officers injured?

    1. Yes
    2. No
29. If Yes, What were the injuries?
31. Does the Suspect have any Known Medical or Mental Conditions?*

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

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