NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

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Charge Section Number Addendum C At time of Arrest, was Suspect Under the Influence of: Mental stress/mentally unstable Influence of alcohol Influence of drugs Was Officer Injured? Yes No If yes, nature of injuries: Was Officer transported to Hospital? Yes No Admitted Hospital: Transported by: Attending physician: Reporting Officer: Name: Badge Number DOB Date of Hire Signature Date PD-99-209 Revised February 2012 Page | 3

Addendum C For Supervisor Use Only Supervisor’s Summary: Signature Date Under Investigation Use of Force Justified Use of Force Not Justified Reporting Supervisor: Defense Tactics Instructor: Chief of Police: Date: Date: Date: PD-99-209 Revised February 2012 Page | 4

Charge<br />

Section Number<br />

Addendum C<br />

At time of Arrest, was Suspect Under the Influence of:<br />

Mental stress/mentally unstable Influence of alcohol Influence of drugs<br />

Was Officer Injured?<br />

Yes No<br />

If yes, nature of injuries:<br />

Was Officer transported to Hospital?<br />

Yes No Admitted<br />

Hospital:<br />

Transported by:<br />

Attending<br />

physician:<br />

Reporting Officer:<br />

Name:<br />

Badge<br />

Number<br />

DOB<br />

Date of Hire<br />

Signature<br />

Date<br />

PD-99-209<br />

Revised February 2012<br />

Page | 3

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