Police Checkpoint Report Form
Document details of a police checkpoint stop and its outcome accurately.
Date of Checkpoint Stop
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Stop
*
Hour Minutes
AM
PM
AM/PM Option
Checkpoint/Location Description
*
Reporting Officer Name or Badge Identifier
*
Vehicle Type
*
Please Select
Car
Motorcycle
Truck
Van
Bus
Bicycle
Other
Vehicle Make, Model, and Color
*
Driver Name
*
Reason for Stop
*
Please Select
Routine Check
Traffic Violation
Suspicious Behavior
DUI/DWI Check
Vehicle Defect
Other
Outcome of the Stop
*
Please Select
No Action
Warning Issued
Citation Issued
Arrest Made
Vehicle Searched
Other
Incident/Report Notes
Submit Report
Should be Empty: