Service Weapon Discharge Incident Report Form
Please complete the Service Weapon Discharge Incident Report Form to document the details of the incident accurately.
Officer Full Name
*
First Name
Last Name
Badge or Employee ID
*
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Incident Location
*
Type of Service Weapon
*
Please Select
Handgun
Rifle
Shotgun
Other
Reason for Discharge
*
Please Select
Self-defense
Animal threat
Accidental discharge
Training exercise
Other
Describe the Incident
*
Were there any injuries?
*
No
Yes
Witnesses (names and contact, if any)
Supervisor Notified
*
Yes
No
Submit Report
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