NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

Addendum D
Discharge of Firearm Report
Report Number
Incident Location
Incident Date
Incident Time
Duty Status:
On Duty Off Duty With Backup Alone Special Duty Uniform Non-Uniform
How did Officer Become Involved in Incident?
Dispatched Run On View
Type of Incident:
Domestic Dispute Traffic Stop Robbery Burglary Individual with weapon
Other:
Why did Officer Use Weapon?
To Protect Citizen To Protect Self To Prevent Dangerous Felony
To Prevent Escape of a Dangerous Felon Other:
Was There any Physical Exertion or Other Use of Force Prior to Incident?
Physical Struggle Running OC Chemical Irritant ASP Baton
Other:
Type of Cover Used by Officer:
Officer’s Weapon:
Qualified with weapon used: Yes No
Issued Handgun Personal Weapon Date of last qualification: _________________
Model:
Barrel Length:
Caliber:
Ammunition: Departmental Issued Other:
Number of Shots Fired by Officer:
Officer’s Weapon Con’t
Single Action Double Action Two Handed One Handed
PD-99-210
Revised February 2012 Page | 1