NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

Report Number:
Victim’s statement of frequency and severity of prior incidents of abuse by suspect:
Addendum C
Number of times Victim has called Police and outcome:
Signs of Drug or Alcohol Abuse:
If Victim will be staying at temporary address, listed address and phone number:
Property Impound Number:
Evidence Collected
Photo(s) of Victim’s Injuries
Weapon(s) used during incident - Describe:
Damaged Property
Copy of 911 Call
Copy of Cruiser Video
Victim’s Clothing
Other – Describe:
Victim Services Information was given to Victim including Officer’s Name and Badge #
Follow-up Photos Needed - describe type/area to be: ________________________________________________
Officer’s Observations of Victim and Suspect
Victim
Suspect
Afraid
Angry
Apologetic
Children Present During Abuse:
Yes No
Calm Child Victim? Yes No
Crying Children Services Notified? Yes No
Hysterical Elderly Victim? Yes No
Nervous Adult Protective Services Notified? Yes No
Polite Existing Protection Orders: Yes No
Threatening
Other:
___________________________
Jurisdiction: _________________________________________
Order #
_________________________________________
Expiration Date: _____________________________________
Criminal
Civil
PD-99-108
Revised March 21, 2011