ATLANTA POLICE DEPARTMENT

SPECIAL OPERATIONS SECTION/RED DOG

Supervisor’s Report of Injury to Citizen

TO:
FROM:

DATE OF INCIDENT:
RESPONDING SUPERVISOR’S NAME:
FORM FILLED OUT BY:

COMPLAINT NUMBER:
TEAM /UNIT#:

(LIST INDIVIDUAL NAMES OF TEAM MEMBERS)

LOCATION:
TIME:
ARREST COPY NO CHARGES (PLEASE CHECK ONE THAT APPLIES)

INJURED PERSON’S NAME:
INJURED PERSON’S ADDRESS:
INJURED PERSON’S PHONE NUMBER:

DID AMBULANCE RESPOND?	YES NO

(IF SO, INDICATE NAME & UNIT)

INDICATE TYPE OF TREATMENT ,IF ANY:

WAS PERSON TRANSPORTED TO HOSPITAL?	YES NO

(IF SO, INDICATE HOW TRANSPORTED & HOSPITAL)

1.	WITNESS NAME:
WITNESS ADDRESS:
WITNESS PHONE NUMBER:

2.	WITNESS NAME:
WITNESS ADDRESS:
WITNESS PHONE NUMBER:

DESCRIBE INJURY:

Supervisor’s Report of Injury to Citizen (Continued)

NARRATIVE (BRIEF DESCRIPTION OF INCIDENT)

WERE PHOTOS TAKEN?	YES NO

(PLEASE ATTACH COPY OF REPORT & PHOTOS.)

Reporting Officer Signature: _______________________________ Date:___________

cc:	Unit file

Unit commander

Form APD 635 Revised 3/26/02

FIRST REPORT OF INJURY

VWarnic

2002-03-26

Richard Clarke