NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

ADDENDUM C
VEHICULAR PURSUIT REPORT
Report Number: _______________________________
Date:____________________ Time: __________
Primary
Cruiser and
Officer(s):
Cruiser
No._______
Last First MI Rank Sex Age Assignment Years of Service
Last First MI Rank Sex Age Assignment Years of Service
Secondary
Cruiser and
Officer(s):
Cruiser
No._______
Other Cruiser(s) Numbers:
Initial Incident:
Last First MI Rank Sex Age Assignment Years of Service
Last First MI Rank Sex Age Assignment Years of Service
Pursuit Area:
Weather Conditions:
Light Conditions:
Traffic Violator
DWI
Criminal/Felony
Outside Agency
Other (specify)
_______________________
_______________________
_______________________
Freeway
Business District
Main Thoroughfare
Residential
School Zone
Alley
Rural
Side Street
Other (specify)
______________________
Clear
Rain
Snow
Fog
Ice
High Wind
Other (specify)
______________________
______________________
Daylight/Sunny
Daylight/Overcast
Dawn/Dusk
Dark/Lighted
Dark/No Lights
Traffic Conditions:
Light
Moderate
Heavy
Pedestrians
Helicopter Involved: Yes
No
Maximum Speed Attained
Est. MPH: ____________
Pursuing Officer Familiar with area:
Yes No
Pursuit Terminated:
Yes* No
Total Time of Pursuit:
___________ Minutes
Distance Traveled:
______________ Miles
Number of Police Vehicles Involved:
_______________
*By Whom:
_________________________
Pursuing
Officers:
Fleeing
Driver:
Offensive Action:
(Ramming, etc.)
Fleeing Vehicle
Information:
Accident:
Yes No
Defensive Action: _________________________________________________________________________________________________
Offensive Action: _________________________________________________________________________________________________
(road block, ramming, etc.)
____________________________________ ________________________________________________ _______ _______ _______
Name Address Sex Age Race
Driver apprehended:
Yes No
Valid License:
Yes No
Alcohol/Drugs
Suspected:
Yes No
Year: Make: Model: Color: License Plate #: State:
Accident Type:
Property Damage
Injury Fatal
Vehicles Involved:
Police Suspect
Other _______________
Total Number of Vehicles
# of
Passengers:
Involved:_________________
PD-99-109
Revised December 13, 2010