Form 1-701 Analysis of Law Enforcement Officers Killed or Assaulted

1-701 (Rev. 1-10-07)

OMB No. 1110-0009
Expires 2-29-10

ANALYSIS OF LAW ENFORCEMENT OFFICERS KILLED AND ASSAULTED
Agency

Agency Identifier

Assault with Injury

Agency Address

Feloniously Killed
Accidental Death
(Complete 1-14 and 56 only)

This report is authorized by law Title 28, Section 534, U.S. Code. Please use this form to report circumstances regarding law
enforcement officers of your department who were killed or who were assaulted and injured with a firearm or a knife or other
cutting instrument. The information submitted will assist the FBI in the compilation of the annual publication, Law Enforcement
Officers Killed and Assaulted, providing valuable data for law enforcement purposes, including police training. Your cooperation
is appreciated

PART I - PERSONAL DATA PERTAINING TO VICTIM OFFICER
1. Name:
Last

First

2. Rank:

Middle

3. Total law enforcement experience:

/
Years

/

4. Date of birth:
Month
6. Race:

White
Black

/
Day

5. Sex:

Male

Months

Female

Year

American Indian / Alaskan Native

/

7. Height:
Feet

Asian / Pacific Islander

Inches

Weight:
8. Was victim officer certified/licensed by state, by P.O.S.T (Police Officer Standards Training), or by a federal law enforcement
training academy?
Yes
No
(A) If yes, number of months since officer's last firearms training. (enter 00 if no training received):
(B) If yes, number of months since officer's last defensive tactics training. (enter 00 if no training received):

PART II - CIRCUMSTANCES SURROUNDING THE ASSAULT OR DEATH OF VICTIM OFFICER
9. Situation in which assault or death occurred:
(A) Check the circumstance that best describes the assault with injury or felonious killing; if accidental death, skip to (B):
Disturbance call (bar fights, person with firearm, etc.)
Domestic disturbance call (family quarrels)
Burglary in progress or pursuing burglary suspects
Robbery in progress or pursuing robbery suspects
Drug-related matter (drug busts, buys, etc.)
Attempting other arrest (excludes burglary and robbery arrest)
DO NOT WRITE HERE

Civil disorder (mass disobedience, riot, etc.)

File Number

Handling, transporting, custody of prisoners

Incident Number

Investigating suspicious persons or circumstances

ORI Number
Group

Ambush (entrapment and premeditation)

Region
Division
Date and Initials

Ambush (unprovoked attack)

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Investigative activity (surveillance, searches, interviews, etc.)
Handling persons with mental illness
Traffic pursuits and stops (check one):
Felony vehicle stop

Traffic violation stop

Tactical situation (barricaded offender, hostage taking, or high-risk entry)
Ballistic shield used:

Yes

No

(B) Check the circumstance that best describes the accidental death:
Accidental shooting (crossfire, mistaken for offender, mishap)
Accidental shooting (training mishap)
Accidental shooting (self inflicted, cleaning mishap, or not apparent or confirmed suicide)
Automobile accident (unrelated to enforcement, e.g., an assistance activity)
Automobile accident (related to criminal enforcement activity)
Motorcycle accident (unrelated to enforcement, e.g., an assistance activity)
Motorcycle accident (related to criminal enforcement activity)
Struck by vehicle (unrelated to enforcement, e.g., an assistance activity)
Struck by vehicle (related to criminal enforcement activity)
Aircraft accident
Other accidental (fall, fire, drowning, etc.) (specify):
10. Type of assignment (check one):
Foot patrol

Two-officer vehicle

Special assignment

Off duty

One-officer vehicle

Detective

Undercover

Other
(specify):

11. Involvement of other officers (check one):
Alone, no assistance requested
Alone, assistance requested
Assisted by other officer(s) at time of incident
12. Date, time, and conditions when incident occurred:
Date:

/
Month

Time: (Military HHMM)

/
Day

Year

Weather conditions:

Lighting conditions:

13. Date of victim officer's death:

/
Month

14. Indicate the location of the incident by:

/
Day

Year

City
County

(If accidental death, skip to
number 56.)

State

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Yes

15. If assaulted, has victim officer returned to duty?
If yes, date of return:

/
Month

16.

No

/
Day

Year

If victim officer was assaulted or killed during a traffic stop,
Yes

(A) Did victim officer contact radio dispatcher prior to attack?

No

(B) Please indicate whether (check one):
Victim was approaching offender(s) at time of attack
Victim was returning to police unit at time of attack
Victim was interviewing offender(s) in police unit at time of attack
Other (specify):
(C) Location of offender(s) in suspect vehicle (If multiple offenders, indicate in order, starting with primary suspect as "A."):
Driver

Right front

Center rear

Outside vehicle

Center front

Left rear

Right rear

Unknown

17. Location of circumstances:
Residential

Commercial

Government/public

Inside

Inside

Inside

Outside

Outside

Outside

18. Was cover available to victim officer?
19. Did offender utilize cover?

Yes

Yes

No

If yes, was it used?

Yes

No

No

20. Please indicate the distance between the victim officer and the offender at the time the officer was assaulted or killed
(check one):
0-5 feet

11-20 feet

Over 50 feet

6-10 feet

21-50 feet

Unknown

21. (A) Location of wounds inflicted upon victim officer (check all applicable):
Front head

Neck/throat

Front lower torso/stomach

Rear below waist

Rear head

Front upper torso/chest

Rear lower torso/back

Arms/hands

Side head

Rear upper torso/back

Front below waist

(B) If killed, indicate which location was the fatal wound:
22. Was victim officer wearing protective body armor at time of attack?
If yes and victim was shot in torso area:
(A) Did bullet cause mortal wound?

Yes

No

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Yes

No

(B) How did the bullet circumvent the body armor?
Entered between side panels of vest
Entered through armhole or shoulder area of vest
Entered above vest (front or back of neck, collarbone area, etc.)
Entered below vest (abdominal or lower back area)
Penetrated through the vest (round more powerful than vest's capabilities/specifications)
Penetrated through the vest (body armor failure)
23. Was victim officer in police uniform at time of incident?
Yes

What was uniform color?

No

Was other identification evident? (none, raid jacket, vest, etc.) (specify):

24. Did victim officer have prior knowledge that a weapon might be involved?
Yes

No

Unknown

25. Weapon used to assault or kill victim officer (check one):
Firearm

Personal weapons (hands, fists, feet, etc.)

Knife or other cutting instrument

Vehicle

Bomb

Other
(specify):

Blunt instrument (club, brick, etc.)
(specify):
26. If firearm, description of weapon used to assault or kill victim officer:
Handgun

Rifle

Shotgun

Make:

Cartridge type (include caliber):

Model:

Barrel length:

Type:

Automatic

Revolver

Bolt action

Semiautomatic

Pump

Lever action

27. Was victim officer disarmed during the attack?

Yes

28. Was victim officer assaulted or killed with own weapon?

No

Yes

29. Was victim officer's weapon stolen (taken from scene) by the offender?

30. Did victim officer fire own weapon?

Yes

No

Yes

No (If no, skip to question 32.)

If yes, number of shots fired:

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No

Yes

31. Did victim officer's shots hit the offender(s)?

No

(A) If yes, how many rounds hit offender(s)?
(B) Number of shots fired by other officer(s):
32. If victim officer did not fire service weapon, did he/she attempt to use service weapon by unsnapping holster, drawing
Yes

weapon, or by some other action?

Unknown

No
Yes

If yes, did victim officer's weapon malfunction?

No

Unknown

33. Description of victim officer's service weapon:
Handgun

Rifle

Shotgun

Make:

Cartridge type (include caliber):

Model:

Barrel length:

Type:

Automatic

Revolver

Bolt action

Semiautomatic

Pump

Lever action
Yes

34. Did victim officer carry a backup weapon?

No
Yes

(A) If yes, did victim officer use the backup weapon?

No

(B) If yes, type of backup weapon used:
(a)

Handgun

Rifle

Shotgun

Make:

Cartridge type (include caliber):

Model:

Barrel length:

Type:

Automatic

Revolver

Bolt action

Semiautomatic

Pump

Lever action

(b) Other defensive weapon (baton, Mace, etc.) (specify):

36. Did victim officer reload during incident?

No (If no, skip to question 37.)

Yes

35. Did victim officer have extra ammunition?

Yes

No
Yes

37. Was victim officer wearing a holster at time of incident?

Unknown
No

If yes,
(A) Type of holster:

Crossdraw

(B) Model of holster:

Strapover

38. Number of shots fired by offender(s):

Sidedraw

Shoulder

Thumb release

Flaptop

Unknown
Unknown

39. Number of offenders present at time of incident:

Page 5

Other
(specify):
Other
(specify):

PART III - OFFENDER DATA
Even though your agency may not have complete information concerning the offender(s), please provide the data you have available.
If more than one offender is involved in the incident, please complete ADDITIONAL OFFENDER DATA SHEETS for each offender.
Complete these sheets only for known offender(s) and accomplice(s) involved in the victim officer's killing or assault and not for
those individuals merely present at the scene. These data will be published with national data only in aggregate and not identified
by individual agency or person. In answering the following items, it is assumed that the offender(s) is at least identified if not
in custody.
40. Offender's name:
Last

First

Middle

If multiple offenders, please note offender's sequence number as in question 16 (C):
41. Offender's date of birth:

/
Month

/
Day

Year

42. Offender's sex:

Male

Female

43. Offender's race:

White

American Indian / Alaskan Native

Black

Asian / Pacific Islander

Unknown

/

44. Offender's height:
Feet

Inches

Offender's weight:
45. Offender's place of birth:
City

County

State/Country

46. Offender's current or last known residence:
City

County

47. Offender's FBI number:
48. Offender's current status (check all applicable):
At large
Deceased, justifiably killed by victim officer
Deceased, justifiably killed by person(s) other than victim officer
Committed suicide
Deceased, died under other circumstances
Wounded by victim officer
Wounded by person(s) other than victim officer
/

Arrested (specify date of arrest):
Month

/
Day

Year

Charges placed against offender:
Other (specify):

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State

49. Offender's prior arrests known to your department:

50. Was offender under judicial supervision at time of incident?
Yes

No

Unknown

If yes, offender was on:
Probation

Escapee from penal institution

Parole

Conditional release, pending criminal prosecution

Halfway house

51. Is offender known to your department as a user, dealer, or possessor of a controlled substance (narcotics)?
Yes

No

Unknown

If yes, offender was:
User

Dealer

Possessor

52. Was offender under the influence of a controlled substance (narcotics) at time of incident?
Yes

No

Unknown

53. Was offender intoxicated or under the influence of alcohol at time of incident?
Yes

No

Unknown

54. Was offender known to your department as having prior mental disorders?
Yes

No

55. Relationship between victim officer and offender (check one):
Victim officer and offender had prior relationship through law enforcement (such as arrest, investigation, etc.
Victim officer and offender had non-law enforcement relationship (such as neighbor, acquaintance, relative, etc.
No known relationship

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56. Written Summation:
Because a synopsis of each felonious police killing is included in the annual publication, Law Enforcement Officers
Killed and Assaulted , pertinent details from the victim officer's agency are necessary to present a useful narrative concerning
the officer's death. Likewise, details regarding serious assaults and accidental line-of-duty deaths are useful. Therefore, in
the space below, you are requested to provide a written summation of the events surrounding the victim officer's death/assault.
The success of our endeavors to prevent further line-of-duty deaths by presenting information which may be incorporated into
police training programs depends to a large extent on the quality of data obtained from the victim officer's agency. (Please
type or print clearly.)

/
Month

Prepared by: (Please print clearly.)
NOTE:

/
Day

Year

If this questionnaire was completed because an officer was assaulted and sustained personal injury with a firearm or a
knife or other cutting instrument, we ask that the report be forwarded to the agency's state Uniform Crime Reporting
Program or forwarded directly to the FBI, Criminal Justice Information Services Division, Attention: LEOKA Program,
Module E-3, 1000 Custer Hollow Road, Clarksburg, West Virginia 26306; telephone (304) 625-4830, or facsimile to
(304) 625-3566. Otherwise, this questionnaire should be forwarded to the local FBI field office. Under the Paperwork
Reduction Act, you are not required to complete this form unless it contains a valid OMB control number. The form takes
approximately one hour to complete.

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