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pdf1-701 (Rev. 08-17-09)
OMB NO. 1110-0009
Expires
Law Enforcement Officers Killed and Assaulted Program
ANALYSIS OF OFFICERS FELONIOUSLY KILLED AND ASSAULTED
This report is authorized by law Title 28, Section 534, U.S. Code. Please use this form to report
circumstances and other details regarding law enforcement officers from your department who were
killed or assaulted and injured with a firearm or a knife or other cutting instrument. The information you
submit will assist the FBI in the compilation of the annual publication, Law Enforcement Officers Killed
and Assaulted, and will also provide valuable data for law enforcement purposes, including officer
training. Your cooperation, time, and effort are appreciated.
DATA PERTAINING TO VICTIM OFFICER’S AGENCY
Agency _______________________________________
Originating Agency Identifier (ORI) _________________
Head of agency _______________________________________________________________________________
Rank/Title
First
Middle (If no middle name, indicate ‘NMN.’)
Last
Agency address _______________________________________________________________________________
Mailing address
City
State
Zip code
Victim officer’s assigned office (Do not complete if information is same as above.)
Precinct, district, troop, barracks, region, etc. __________________________________________________
Head of assigned office _____________________________________________________________________
Rank/Title
First
Middle (If no middle name, indicate ‘NMN.’)
Last
Address of assigned office ___________________________________________________________________
Mailing address
Type of agency
City
County
State
City
State
Zip code
Federal
Tribal (non-federal only)
Other (specify) ___________________
GENERAL DATA PERTAINING TO INCIDENT
Type of incident
Felonious killing
Assault with injury
Firearm
Knife/other cutting instrument
Other dangerous weapon
Personal weapons (hands, fists, feet, etc.)
DO NOT WRITE HERE
File Number
Incident Number
Group
Region
Division
Received
Entered
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Agency incident or case number ______________________
Date of incident ______ / ______ / ______
(mm/dd/yyyy)
Time of incident ________________________________
(Military hhmm)
Number of hours on duty prior to incident ____________
Location of incident
City
_____________________________________________
County _____________________________________________
State
_____________________________________________
Country _____________________________________________
Type and description of location of incident
Location of
initial contact
with offender(s)
Location of
attack on
victim officer
Residential
Commercial
Government
Highway/road/alley/sidewalk
Lakes/rivers/parks
Other public space (specify) _____________
Other (specify) ___________________________
Inside of structure
Outside
Type of location
Public space
Description of location
PART I – PERSONAL DATA PERTAINING TO VICTIM OFFICER
1.1
Name _______________________________________________________________________________
First
Middle (If no middle name, indicate ‘NMN.’)
1.2
Rank _______________________________________
1.3
Date of birth ______ / ______ / ______
(mm/dd/yyyy)
1.4
Height ______ / ______
(feet/inches)
1.5
Weight ________ lbs
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Sex
Male
Female
1.7
Race
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
1.8
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
1.9
Total law enforcement experience at time of incident ______ / ______
(years/months)
1.10
Was victim officer certified/licensed by federal, regional, state, local, or POST (Police Officer
Standard Training) academy?
Yes
No
1.11
Number of months since officer’s last firearm training ____ (Enter 0 if no training received.)
1.12
Number of months since officer’s last driver training _____ (Enter 0 if no training received.)
1.13
Number of months since officer’s last street survival training _____ (Enter 0 if no training received.)
1.14
In the 48 hours immediately preceding incident, how many hours did victim officer work in a law
enforcement capacity? _____ hours
1.15
In the 48 hours immediately preceding incident, how many hours did victim officer work in a nonlaw enforcement capacity? _____ hours
PART II – CIRCUMSTANCES SURROUNDING INCIDENT
2.1
Death or injury occurred while victim officer was
Conducting self-initiated activity
Answering call for service
2.2
Type of assignment
One-officer patrol
Two-officer patrol
Investigative/detective
Tactical assignment (uniformed)
Plainclothes assignment
Special assignment (specify) ___________________
Undercover
Court/prisoner security
Overtime/extra duty activity
Off duty, but acting in an official capacity
Other (specify) ___________________
Victim officer’s mode of transportation
Car/truck/SUV
Motorcycle
Foot
Bicycle
Mounted
Watercraft
Undercover vehicle
Personal vehicle
Aircraft
Other (specify) ___________________
2.3
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Mode of transportation
Marked
Unmarked
Not applicable
2.4
Involvement of other officers at time of incident
Alone, no assistance requested
Alone, assistance requested
Assisted by other officer(s)
2.5
Did victim officer contact radio dispatch at any point during incident?
Yes
At what point during attack did victim officer initially contact dispatch?
Before
During
After
Unknown
No
Unknown
2.6
Approximately how much time elapsed from initial contact between victim officer and offender until
actual attack?
Sudden/blitz
Within 1-10 minutes
Within 10-30 seconds
Longer than 10 minutes
Within 30-60 seconds
Unknown
2.7
Approximate distance (in feet) between victim officer and offender(s) at time victim officer was
initially attacked _________ Unknown
2.8
Select one from each column.
Call for
service or
reason for
involvement
Circumstance
encountered
upon arrival
at scene of
incident
Specific
activity being
performed at
time of attack
Citizen complaint
Animal bite
Animal disturbance (barking dog, unleashed dog, etc.)
Verbal complaints of non-criminal violations
Check on welfare of citizen
Drug complaint
Business check
Traffic complaint
Respond to crime in progress
Assault
Robbery
Burglary
Larceny-theft
Motor vehicle theft
Person with firearm (no shots fired)
Shooting/shots fired
Tampering with vehicle
Other crime against person
Other crime against property
(Continued on next page)
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Call for
service or
reason for
involvement
Circumstance
encountered
upon arrival
at scene of
incident
Specific
activity being
performed at
time of attack
Respond to alarm
Burglary
Robbery
Disorder/disturbance
Civil disorder (mass disobedience, riot, etc.)
Disturbance call (disorderly subjects, fights, etc.)
Domestic disturbance (family quarrels, no assault)
Domestic violence
Respond to report of crime
Homicide
Assault
Robbery
Burglary
Larceny-theft
Motor vehicle theft
Person with firearm (no shots fired)
Shooting/shots fired
Tampering with vehicle
Other crime against person
Other crime against property
Assist another law enforcement officer in
Officer down (requiring emergency assistance)
Officer requires emergency assistance (not pursuit)
Vehicular pursuit
Foot pursuit
Other emergency circumstances
Providing/deploying equipment (traffic cones,
flares, etc.)
Other non-emergency circumstances
Investigative/enforcement
Investigative activity
Investigate suspicious persons or circumstances
Investigate possible DUI/DWI suspect (operating a
vehicle)
Felony traffic stop
Traffic violation stop
Investigate motor vehicle crash
Wanted person
Handling persons with mental illness
Tactical situation
Undercover situation
Drug-related matter (drug busts, buys, etc.)
(Continued on next page)
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Call for
service or
reason for
involvement
Circumstance
encountered
upon arrival
at scene of
incident
Specific
activity being
performed at
time of attack
Arrest situation
Verbal advisement only
Attempting to restrain, control, or handcuff offender
Pursuit
Vehicular
Foot
Ambush (entrapment/premeditation)
Unprovoked attack
Encounter or assist an emotionally disturbed person
Traffic control (crash scene, directing traffic, etc.)
Assist motorist
Administrative assignment
Prisoner transport
Other administrative assignment
Other (specify) _________________________________
Complete following items if incident was related to prisoner transport circumstance. (Skip to Item 2.10
if not applicable.)
2.9.1
Prisoner was being transported in
Prisoner transport wagon
Prisoner transport bus
Patrol vehicle
Unmarked vehicle
Other (specify) _________________________________
2.9.2
Was transporting vehicle equipped with prisoner partition?
Yes
No
Unknown
2.9.3
Was prisoner searched by transporting officer prior to being put in vehicle?
Yes
No
Unknown
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2.10
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Complete following items if activity being performed at time of attack was related to traffic stop
(including investigation of DUI). (Skip to Part III if not applicable.)
2.10.1
Was traffic stop videotaped?
Yes
No
2.10.2
Location of offender(s) at time of attack (Complete additional sheets if more than two offenders.)
Offender’s name
Location of offender(s) at time of attack
Seated in
_________________________
Suspect vehicle
First
Middle
Last
Victim officer’s vehicle
Seated outside in vicinity of suspect vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Seated outside in vicinity of victim officer’s vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Standing in vicinity of suspect vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Standing in vicinity of victim officer’s vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Unrestricted movement outside of
Suspect vehicle
Victim officer’s vehicle
Prone
On ground
On vehicle/object
Other (specify) ________________________
Unknown
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Additional offender’s name
Not applicable
_________________________
First
2.10.3
Middle
Last
Location of offender(s) at time of attack
Seated in
Suspect vehicle
Victim officer’s vehicle
Seated outside in vicinity of suspect vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Seated outside in vicinity of victim officer’s vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Standing in vicinity of suspect vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Standing in vicinity of victim officer’s vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Unrestricted movement outside of
Suspect vehicle
Victim officer’s vehicle
Prone
On ground
On vehicle/object
Other (specify) ________________________
Unknown
Location of victim officer at time of attack
Seated in victim officer’s vehicle
Prior to approaching suspect vehicle
After obtaining contact with offender(s)
Approaching suspect vehicle on
Driver’s side
Passenger’s side
Standing in vicinity of suspect vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Standing in vicinity of victim officer’s vehicle
Front driver’s side
Front passenger’s side
Rear driver’s side
Rear passenger’s side
Other
Approaching offender
Returning to victim officer’s vehicle
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PART III – ENVIRONMENTAL FACTORS
3.1
3.2
Weather conditions at time of incident
Clear
Cloudy
Fog, smoke, smog
Rain
Flooding
Sleet, hail
Snow
Blizzard
Lighting conditions at location of incident
Dawn
Daylight
Dusk
Dark
Artificial
Unknown
3.2.1
Severe crosswinds
Hurricane
Tornado
Blowing sand, soil, dirt
Other (specify) ___________________
Unknown
Not applicable (indoors)
Would lighting conditions have been considered dim or poor?
Yes
No
Unknown
3.3
Were take down lights utilized?
Yes
No
Unknown
3.4
Was cover available to victim officer?
Yes
Was it used?
Yes, description of actual cover used ______________________________
No
Unknown
No
3.5
Was cover used by offender(s)?
Yes, description of actual cover used ______________________________
No
Unknown
PART IV – INJURIES CONNECTED TO INCIDENT
4.1
Location of injuries inflicted upon victim officer (select all applicable)
Front head
Rear lower torso/back
Rear head
Front below waist/groin area
Side head
Rear below waist/buttocks
Neck/throat
Arms/hands
Front upper torso/chest
Front legs/feet
Rear upper torso/back
Rear legs
Front lower torso/abdomen
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Was victim officer killed in incident?
Yes
Indicate one wound location selected in Item 4.1 as fatal injury. _____________________
Unable to determine
Date of victim officer’s death ______ / ______ / ______
(mm/dd/yyyy)
No
How severe were victim officer’s injuries?
Superficial (treated at scene of incident)
Minor (treated at hospital and released)
Moderate (admitted to hospital)
Severe (admitted to hospital with critical injuries)
Has victim officer returned to duty?
Yes
No
Is victim officer expected to be permanently disabled?
Yes
No
Unknown
PART V – PROTECTIVE/SAFETY EQUIPMENT
5.1
Was victim officer required to wear protective body armor at time of incident?
Yes
No
5.2
Was victim officer wearing protective body armor at time of incident?
Yes
No
What was indicated as possible reason why victim officer was not wearing protective body
armor? (Select one then skip to 5.3.)
Excessive heat or humidity
Off duty
General discomfort
Other (specify) ___________________
Undercover assignment
Unknown
5.2.1
What was classification of protective body armor? (If two or more different levels of
protection, indicate minimum ballistic protection.)
Type I
Type III
Type IIA
Type IV
Type II
Special type (specify) ______________
Type IIIA
Unknown
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Did protective body armor prevent round(s) or cutting instrument(s) from entering victim
officer’s body?
Yes
Could the round(s) or cutting instrument(s) have caused a mortal wound?
Yes
No
Did victim officer receive injuries due to blunt force trauma?
Yes
No
No
How did round(s) or cutting instrument(s) circumvent protective 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 vest (round more powerful than vest’s
capabilities/specifications)
Penetrated through vest (protective body armor failure)
Number of times protective body armor was circumvented ________
5.3
Was victim officer wearing uniform at time of incident?
Yes
Type of uniform
Patrol
Utility
Tactical
Other (specify) ______________________________
Were there obvious markings on uniform that would have identified victim officer as law
enforcement?
Yes
No
Unknown
Primary color of uniform ________________________________
No
Did victim officer verbally identify him/herself as law enforcement?
Yes
No
Unknown
Was other identification evident?
Yes
Description of other identification
Badge displayed
Vest with law enforcement markings
Raid jacket with law enforcement markings
Armband
Other (specify) ______________________________
No
Unknown
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Did victim officer use ballistic shield during incident?
Yes
Did ballistic shield successfully deflect any rounds?
Yes
No
Unknown
Not applicable (not fired upon)
No (equipped with ballistic shield)
Unknown
Not applicable (not equipped with ballistic shield)
PART VI – WEAPON USE DURING INCIDENT
The following items refer to weapons brought to scene of incident by victim officer and victim officer’s use of
his/her weapons during incident.
6.1
Indicate all that apply for each column.
Service weapon (firearm)
Backup firearm
Additional firearm
Baton
Knife
(blade length in inches)
Other cutting instrument
(specify)
Bean bag gun
Conductive energy device (Taser, etc.)
Chemical spray (Mace, pepper spray, etc.)
Other
(specify)
None
Weapon(s) victim
officer had upon
arrival at scene of
incident
______________
______________
______________
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Weapon(s) victim
officer used
during incident
______________
______________
_____________
Weapon(s) victim
officer attempted
to use during
incident
______________
______________
____________
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Was victim officer wearing holster at time of incident?
Yes
No
If yes, type of holster
Service weapon (firearm)
Duty/tactical
Crossdraw
Sidedraw
Thigh
Concealment
Inside waist band (IWB)
Shoulder
Belly band/waistpack
Ankle
Groin
Pocket
Other (specify) ________________________
No holster
Retention level classification
(e.g., 1,2,3, etc.) __________
Retention level classification
(e.g., 1,2,3, etc.) __________
6.3
Backup firearm
Duty/tactical
Crossdraw
Sidedraw
Thigh
Concealment
Inside waist band (IWB)
Shoulder
Belly band/waistpack
Ankle
Groin
Pocket
Other (specify) ________________________
Did not have backup firearm
No holster
Description of firearm(s) victim officer had upon arrival at scene
Service weapon (firearm)
Backup firearm
Description
Handgun
Handgun
Rifle
Rifle
Shotgun
Shotgun
Additional firearm
Handgun
Rifle
Shotgun
Make
______________________
_______________________
________________________
Model
Cartridge type
(include
caliber)
Barrel length
(in inches)
Type
______________________
_______________________
________________________
______________________
_______________________
________________________
______________________
_______________________
________________________
Location of
weapon at time
of attack
Automatic
Semiautomatic
Revolver
Pump
Bolt action
Lever action
On person
Holstered
Not holstered
In vehicle
Other location (specify)
___________________
Automatic
Semiautomatic
Revolver
Pump
Bolt action
Lever action
On person
Holstered
Not holstered
In vehicle
Other location (specify)
___________________
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Automatic
Semiautomatic
Revolver
Pump
Bolt action
Lever action
On person
Holstered
Not holstered
In vehicle
Other location (specify)
___________________
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6.3.1
When did victim officer use or attempt to use his/her firearm(s) during incident?
Prior to offender initiating an attack
About same time as attack was initiated
After offender initiated attack
Unknown
6.3.2
Did victim officer experience difficulty in retrieving his/her firearm(s) during incident?
Yes
No
If yes, indicate specific reason.
Service weapon (firearm)
Disarmed by offender(s)
Severely injured
Physically prevented from
retrieving weapon
Experienced difficulty or
delay in removing weapon
from holster
Weapon was not on person
(stored in vehicle, briefcase,
or other location)
Other (specify) _________
Unknown
6.3.3
Backup firearm
Disarmed by offender(s)
Severely injured
Physically prevented from
retrieving weapon
Experienced difficulty or
delay in removing weapon
from holster
Weapon was not on person
(stored in vehicle,
briefcase, or other location)
Other (specify) _________
Unknown
Did not have backup
firearm
Additional firearm
Disarmed by offender(s)
Severely injured
Physically prevented from
retrieving weapon
Experienced difficulty or
delay in removing weapon
from holster
Weapon was not on person
(stored in vehicle, briefcase,
or other location)
Other (specify) _________
Unknown
Did not have additional
firearm
Did victim officer’s firearm(s) malfunction during use or attempted use?
Yes
No
If yes, indicate specific reason for malfunction.
Service weapon (firearm)
Backup firearm
Faulty ammunition
Faulty ammunition
Improper ammunition
Improper ammunition
No round in chamber
No round in chamber
Stovepiped
Stovepiped
Other (specify)
Other (specify)
_____________________
_____________________
Unknown
Unknown
Did not have backup
firearm
Did malfunction occur after
initial round was fired?
Yes
No
Unknown
Did malfunction occur after
initial round was fired?
Yes
No
Unknown
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Additional firearm
Faulty ammunition
Improper ammunition
No round in chamber
Stovepiped
Other (specify)
___________________
Unknown
Did not have additional
firearm
Did malfunction occur after
initial round was fired?
Yes
No
Unknown
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6.3.4
Did victim officer fire his/her firearm(s) during incident?
Yes
At what point did victim officer use firearm(s)?
Before receiving injury
About same time as receiving injury
After receiving injury
Unknown
Number of rounds fired by victim officer _________
Did rounds hit offender(s)?
Yes, number of rounds _________
No
Unknown
If rounds struck offender(s), what was effect?
No effect
Tended to irritate/enrage
Caused disabling effect
Other (specify) ___________________
Unknown
Approximate distance (in feet) between victim officer and offender(s) at time victim
officer fired his/her firearm(s) _________ Unknown
No
6.3.5
Did victim officer carry extra ammunition on his/her person during incident?
Yes
No
6.3.6
Did victim officer reload?
Yes
Type of reloading device
Magazine
Speed loader
Loose rounds
Other (specify) ___________________
No
6.4
If victim officer used any weapon other than firearm during incident, what was effect on offender(s)?
No effect
Other (specify) ___________________
Tended to irritate/enrage
Unknown
Caused disabling effect
Not applicable
6.5
If assisted at scene of incident, did other officers fire at offender(s) at scene of initial attack?
Yes
Number of rounds fired by assisting officers ____________
Did any rounds hit offender(s)?
Yes, number of rounds ____________
No
Unknown
No
Not applicable
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The following items refer to weapons carried and/or used by offender(s) during incident.
6.6
Did victim officer have prior knowledge that a weapon might be involved?
Yes
No
Unknown
6.7
Indicate all that apply for each column for weapons brought to scene of incident by victim officer
and/or used against victim officer.
Weapon(s)
Victim officer’s
Victim officer’s
offender(s)
weapon(s) used
weapon(s) taken
took/disarmed
by offender(s) to
from scene of
from victim
kill/assault
incident by
officer during
victim officer
offender(s)
incident
Service weapon (firearm)
Backup firearm
Additional firearm
Baton
Knife
(Indicate blade length in inches)
______________
______________
____________
Other cutting instrument
(specify)
______________
______________
____________
Bean bag gun
Conductive energy device (Taser, etc.)
Chemical spray (Mace, pepper spray, etc.)
Other
(specify)
______________
______________
____________
None
6.8
Indicate all that apply for each column in reference to weapons brought to scene of incident by
offender(s) and their use against victim officer.
Weapon(s)
Offender’s
offender(s) had
weapon(s) used
upon arrival at
to kill/assault
scene of incident
victim officer
Firearm
Additional firearm
Knife
(indicate blade length in inches)
______________ ______________
Other Cutting Instrument
(specify)
______________ ______________
Bomb
Blunt Instrument
Personal weapons (hands, fists, feet, etc.)
Vehicle
Other
(specify)
______________ ______________
None
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6.8.1
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Description of offender’s firearm(s) used to kill/assault victim officer
Firearm
Additional firearm
Description
Handgun
Handgun
Rifle
Rifle
Shotgun
Shotgun
Not applicable
Make
_________________________
_________________________
Model
_________________________
_________________________
_________________________
_________________________
_________________________
_________________________
Automatic
Pump
Semiautomatic Bolt action
Revolver
Lever action
Yes
No
Unknown
Automatic
Pump
Semiautomatic Bolt action
Revolver
Lever action
Yes
No
Unknown
Cartridge type
(include caliber)
Barrel length
(in inches)
Type
Was offender’s
weapon altered from
its manufactured
state?
If killed, which
firearm caused
fatal injury?
The following items refer to incidents in which a firearm (the victim officer’s or the offender’s) was used to
kill/assault victim officer.
6.9
Number of rounds fired by offender(s) ____________ Unknown
6.10
Number of rounds that struck victim officer ____________ Unknown
6.11
Approximate distance (in feet) between victim officer and offender(s) at time offender fired weapon
____________ Unknown
6.12
Was firearm recovered?
Yes
No
Unknown
6.13
If rounds were fired by victim officer and offender, who fired first?
Victim officer
Offender
Unknown
Not applicable (victim officer did not fire)
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PART VII – OFFENDER(S) INVOLVED IN INCIDENT
7.1
Number of individuals determined by law enforcement investigation to have participated in or aided
and abetted the killing/assault of victim officer ____________ Unknown
PART VIII – OFFENDER DATA
(PROVIDE PART VIII FOR EACH OFFENDER)
8.1
Is offender known?
Yes
No (skip to Part IX)
8.2
Offender’s name _______________________________________________________________________
First
8.3
Middle (If no middle name, indicate ‘NMN.’)
Offender’s date of birth ______ / ______ / ______
(mm/dd/yyyy)
8.4
Offender’s height ______ / ______
(feet/inches)
8.5
Offender’s weight ________ lbs
8.6
Offender’s sex
Male
Female
8.7
Offender’s race
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Unknown
8.8
Offender’s ethnicity
Hispanic or Latino
Not Hispanic or Latino
8.9
Is offender a United States citizen?
Yes
No, year offender last entered United States ________ Unknown
Unknown
(yyyy)
8.10
Was offender born in United States?
Yes, name of state ____________________
No, name of United States Territory or foreign country ____________________
Unknown
8.11
Offender’s current or last known residence
City
_____________________________________________
County
_____________________________________________
State
_____________________________________________
Country _____________________________________________
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Offender’s current status (select all applicable)
At large
Arrested
Date of arrest ______ / ______ / ______
(mm/dd/yyyy)
Charges placed against offender _______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Wounded
Method of receiving wounds
By victim officer
By assisting officer(s)
By officer(s) at other scene of incident
By civilian(s)
Other circumstances (specify) __________________________
Deceased
Method of death
Justifiably killed by victim officer
Justifiably killed by assisting officer(s)
Justifiably killed by officer(s) at other scene of incident
Killed by civilian(s)
Committed suicide
Died under other circumstances (specify) __________________________
Date of death ______ / ______ / ______
(mm/dd/yyyy)
Location of death
City
_____________________________________________
County
_____________________________________________
State
_____________________________________________
Country _____________________________________________
Other (specify) ___________________________________________________________
8.13
Can this incident be categorized as a suicide by cop?
Yes
Select one
Suicide by cop
Suspected suicide by cop
Attempted suicide by cop
No
8.14
Offender’s FBI Number ________________________________________ None
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8.15
Was restraint device on offender prior to attack?
Yes
Type of restraint device (select all applicable)
Handcuffs in front
Handcuffs in back
Leg shackles
Other device (specify) ___________________
Did offender manage to defeat/manipulate restraint device?
Yes
Maneuvered handcuffs from back to front
Slipped handcuffs
Unlocked handcuffs
Other (specify) ___________________
No
No
8.16
Offender’s type of judicial supervision at time of incident
Conditional release, pending criminal prosecution
Probation
Parole
Halfway house
Serving time in penal institution
Escapee from penal institution
Other (specify) ___________________
None
Unknown
8.17
Was offender known to your department at time of incident?
Yes
Offender was known as (select all applicable)
Controlled substance user
Controlled substance dealer
Controlled substance possessor
Known or suspected terrorist (domestic or international)
Known or suspected gang member
Other (specify) ________________________
No
8.18
At time of incident, offender was under influence of (select all applicable)
Alcohol
PCP
BAC, if known _______
Other hallucinogens
Crack/Cocaine
Amphetamines/methamphetamines
Cocaine (all forms except Crack)
Other stimulants
Hashish
Barbiturates
Heroin
Other depressants
Marijuana
Other dangerous drug/substance
Morphine
(specify) ______________________
Opium
None
Other Narcotics
Unknown
LSD
8.19
Relationship between victim officer and offender at time of incident (select one)
Prior relationship through law enforcement (arrest, investigation, etc.)
Non-law enforcement relationship (neighbor, acquaintance, relative, etc.)
No known relationship
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8.20
Offender’s judicial history prior to incident (select all applicable)
Previously arrested
House arrest
Conviction as juvenile
Incarceration in penal institution
Conviction as adult
Other (specify) ___________________
Probation
None
Parole
Unknown
Halfway house
8.21
Offender’s prior arrests (select all applicable)
Murder
Assault on law enforcement officer
Resisting arrest
Other crime of violence
Weapons violation
8.22
Drug law violation
Other (specify) ___________________
None
Unknown
Was offender known by your department to have prior mental illness?
Yes
No
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PART IX – NARRATIVE OF INCIDENT
Please provide a detailed description of the circumstances surrounding the felonious assault or death of the victim
officer or attach a copy of the written summation of the initial incident report. Also, if the offender(s) was located or
apprehended later, please provide additional details, such as, when, where, and by whom was the offender located.
This narrative can provide pertinent details that may be incorporated into officer training programs and are often
difficult to capture in a “question and answer” format. The success of our endeavors to prevent further line-of-duty
deaths/assaults depends largely on the quality of data obtained from the victim officer’s agency.
___________________________________________________________________________________________
Prepared by:
(mm/dd/yyyy)
NOTE: If there are any questions on how to complete this form or where to forward the form upon completion,
please contact the FBI, Criminal Justice Information Services Division, Attention: LEOKA program, Module E-3,
1000 Custer Hollow Road, Clarksburg, WV 26306-0159; telephone (304) 625-3521, or facsimile to (304) 625-3566.
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.
Page 22 of 22
| File Type | application/pdf |
| File Title | Microsoft Word - Felonious, injured Race revisions.doc |
| Author | pshanning |
| File Modified | 2010-02-18 |
| File Created | 2010-02-18 |