Shooting Incident Notification

Submitting Officer

Submitting Agency

Submitting Officer Telephone Number

Submitting Officer Email Address

Case Number

Incident Date

Incident Time

Address of Shooting

Type of Scene Zone

Type of Scene Area

Person Hit

If YES - Victim #1 Name

If YES - Victim #1 Address

If YES - Victim #1 DOB

If YES - Victim #1 Type of Injury

Fatal Non-Fatal GSW(s) to limb(s) GSW(s) to head GSW(s) to body/torso GSW(s) to neck GSW(s) to hand/foot Other

If YES - Victim #2 Name

(If Applicable)

If YES - Victim #2 Address

(If Applicable)

If YES - Victim #2 DOB

(If Applicable)

If YES - Victim #2 Type of Injury

(If Applicable)

Fatal Non-Fatal GSW(s) to limb(s) GSW(s) to head GSW(s) to body/torso GSW(s) to neck GSW(s) to hand/foot Other

Property Hit

If YES - Address Struck

List All Addresses If Multiple

Vehicle Hit

(Add Details in Additional Details Section For 3+ Vehicles Struck)

If YES - Vehicle #1 Registration State

(If Applicable)

If YES - Vehicle #1 Registration Number

(If Applicable)

If YES - Vehicle #1 Make

(If Applicable)

If YES - Vehicle #1 Model

(If Applicable)

If YES - Vehicle #2 Registration State

(If Applicable)

If YES - Vehicle #2 Registration Number

(If Applicable)

If YES - Vehicle #2 Make

(If Applicable)

If YES - Vehicle #2 Model

(If Applicable)

Vehicle(s) Used

If YES - Registration State

(If Known / Applicable)

If YES - Registration Number

(If Known / Applicable)

If YES - Vehicle Make

(If Known / Applicable)

If YES - Vehicle Model

(If Known / Applicable)

Number of Shooters/Suspects

Suspect(s) Identified

If YES - Suspect #1 Name

(If Applicable)

If YES - Suspect #1 DOB

(If Applicable)

If YES - Suspect #1 Address

(If Applicable)

If YES - Suspect #1 Arrested?

(If Applicable)

If YES - Suspect #2 Name

(If Applicable)

If YES - Suspect #2 DOB

(If Applicable)

If YES - Suspect #2 Address

(If Applicable)

If YES - Suspect #2 Arrested?

(If Applicable)

Witness(es) to the Incident

(If More Than Two Witnesses, Add Details in Additional Details Section For Witness #3+)

If Yes - Witness #1 Name

(If Applicable)

If Yes - Witness #1 Address

(If Applicable)

If Yes - Witness #1 Telephone Number

(If Applicable)

If Yes - Witness #2 Name

(If Applicable)

If Yes - Witness #2 Address

(If Applicable)

If Yes - Witness #2 Telephone Number

(If Applicable)

Additional Details

Narrative of Shooting Incident

Shooting Incident Notification

INCIDENT INFORMATION

HIT / NO HIT

SUSPECT INFORMATION

WITNESS(ES)

ADDITIONAL DETAILS

NARRATIVE