NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

Dominant Hand
Non-Dominant Hand
Addendum D
Was Weapon Reloaded During Incident? Yes No Number of Reloads _______
Distance From Suspect When:
1) First Shot Was Fired: 2) Last Shot Was Fired:
Estimated Elapsed Time Between First and Last Shot:
Immediately Before Shooting, Was Handgun: Holstered
Already Drawn
Position of Officer:
Standing Sitting Running Kneeling Prone Seated in Vehicle
Other
Injuries Sustained by Officer:
Not Wounded Superficial Critical Fatal
Was Officer Hospitalized?
Yes No If yes, where:
Type of Premises:
Commercial Building Open Area Street Apartment Residence
Other:
Lighting Conditions:
Good Poor Natural Light
Dusk Dawn Other:
Flashlight Day Night Indoors Outdoors
Weather Conditions:
Clear Cloudy Rain Snow Fog
Were Gloves Worn during Shooting?
Yes
No
Multiple Suspects: Yes No Number of Males: Number of Females
Suspect
Name Sex Age Race
Number
1
2
3
PD-99-210
Revised February 2012 Page | 2