Atlanta Police Department

Supervisor’s Use of Force Incident Supplement Form	Control Number:

Officer's Name (Last)

First

MI

Unique ID

Incident/CICA Number

Initial Signal on call?

Division

Section

Unit/Watch

Initial Signal on call?

Force Used
Method of Force Used:	Physical Force OC ASP Firearm	Other (describe):
Were any other officers involved in the use of force? Yes No (if yes, list below)

Did force ease arrest? (explain below) Yes No

OC Spray
Did any other officer spray? Yes No (if yes, who?)
Were any bystanders affected by spray? Yes No (if yes, explain below)	Did spray ease arrest? (explain below) Yes No
Did canister operate properly? Yes No (if no, explain below)	Were you or other officers affected by spray? Yes No

Describe injuries:

ASP Baton
Did any other officer use ASP during arrest? Yes No
List officers involved:	Did ASP usage ease arrest? (explain below) Yes No
Did ASP operate properly? Yes No (if no, explain below)	Injuries? Yes No
Describe injuries:

Firearms
Department issued weapon? Yes No Approved extra weapon? Yes No Other? Yes No (explain below)
Weapon: make / model / serial number / caliber / capacity

Other:
Did weapon operate properly? Yes No (if no, explain below)

How many officers involved in incident?	Injury to officer?
Yes No
Describe injuries:
Firearm Discharge

Type of Discharge:

Number of Rounds Discharged:

Accidental

Intentional

Number of Hits:

Number of Misses:

Range:

Target Hit:

Person Wounded:

Person Deceased:

Location of Wound:

None

Yes

No

Head

Arm

Side

Person

Yes

No

Yes

No

Yes

No

Chest

Leg

Vehicle

Yes

No

Stomach

Back

Structure

Yes

No

Animal Deceased:

Animal

Yes

No

Yes No

If yes what kind?

Other

Yes

No

Investigating Supervisor's Findings:

Investigating Supervisor's signature

Date
Watch Commander's signature
Date
Assistant Zone Commander's signature
Date
Section Commander's signature
Date
Forward original supplement form to: Central Records
Form APD 809 Revised 5/18/09

ATLANTA POLICE DEPARTMENT

vlivsey

2009-05-18

Atlanta Police Department