Federal Bureau of Investigation
Uniform Crime Reporting Program
Law Enforcement Suicide
Data Collection
Suicide or Attempted Suicide
Version 1.0
Document Date: 8/10/2021
Prepared by:
Global Law Enforcement Support Section
Crime Statistics Management Unit
Uniform Crime Reporting Program
Definitions
Attempted suicide – A non-fatal act of self-harm behavior with an intent to die as a result of the behavior.
Former - Having previously occupied a particular role.
Incident – Occurrence of the suicide or attempted suicide.
Incident Date – Date the incident occurred, or the beginning of the time-period in which it occurred, as appropriate.
Law enforcement agency – A federal, state, tribal, or local agency engaged in the prevention, detection, or investigation, prosecution, or adjudication of any violation of the criminal laws of the United States, a state, tribal, or a political subdivision of a state.
Law enforcement officer – Any current or former LEO (including corrections LEO) agent, or employee of the United States, a state, indian tribe, or a political subdivision of a state authorized by law to engage in, or supervise the prevention, detection, investigation, or prosecution of any violation of the criminal laws of the United States, a state, indian tribe, or a political subdivision of a state.
On duty – A LEO is working their assigned shift at the time of incident.
Off duty – A LEO who is not working their assigned shift at the time of incident.
Policy - A standard course of action that has been officially established by an organization, business, political party, etc.
Position Status - Job status of LEO at time of death.
Public Safety Telecommunicators - Operate telephone, radio, or other communication systems to receive and communicate requests for emergency assistance at a primary Public Safety Answering Point (PSAP) (9-1-1 Center) or a secondary (non-9-1-1 Center) PSAP emergency communications centers.
State - Each of the several states, the District of Columbia, and any commonwealth, territory, trust land or possession of the United States.
Suicide – Death caused by a self-harm behavior with an intent to die as a result of the behavior.
Traumatic – Emotionally disturbing or distressing. Relating to or causing psychological trauma whether it is realized or not by the subject.
Law Enforcement Killed and Assaulted
Suicide Data Collection
This report is authorized by the Law Enforcement Suicide Data Collection Act, Title 34, § 50701 and Title 28, § 534, U.S. Code. Please use this form to report circumstances and other details regarding law enforcement officers who have attempted suicide or died by suicide. Information provided throughout this form should apply to data that was available at the time of form completion. The FBI will use this critical information for statistical purposes related to law enforcement, including research, training, and publication. Based on legislation requirements, data submitted within this questionnaire will be reported to the United States Congress and will be accessed on the Internet at https://fbi.gov/cde. Your accuracy, cooperation, effort, and time are critical to our mission and appreciated.
The goal of this collection is to develop, implement, collect, report, and maintain statistics on federal, state, local and tribal law enforcement suicides.
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Are you the employing agency of the individual who attempted or committed suicide?
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Has an attempt to communicate this incident with the employing or previously employing agency been made?
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PART I – ADMINISTRATIVE DATA |
Investigating Agency: _______________________________________ |
Originating Identifier Number (ORI): ____________ |
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Address: |
________________________ |
______________________ |
_____________________ |
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Street/PO Box |
City/State |
Zip Code |
Telephone Number: (___) ________ |
Email Address: ____________________ |
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Employing Agency: |
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Address: |
________________________ |
______________________ |
_____________________ |
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Street/PO Box |
City/State |
Zip Code |
Telephone Number: (___) ________ |
Email Address: ____________________ |
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PART II – PERSONAL DATA RELATIVE TO THE INCIDENT |
Age at time of suicide or attempted suicide: ____________ |
Demographic: |
Race: (choose all that apply – multi-race) |
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☐Male |
☐White |
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☐Female |
☐Black or African American |
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☐ Non-binary |
☐American Indian or Alaska Native |
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☐ Other: (open text) |
☐Asian |
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☐Native Hawaiian or other Pacific Islander |
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☐Hispanic or Latino |
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Total law enforcement work experience at time of incident: |
Position Status: |
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☐0-5 years ☐6-10 years ☐11-15 years ☐16-20 years ☐21-30 years ☐Over 31 years |
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Children:
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BUSINESS RULE: MOVE TO NUMBER OF CHILDREN
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Military Veteran: |
Marital Status at time of incident: |
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☐Yes (BUSINESS RULE: MOVE TO BRANCH OF SERVICE) |
☐Single/Never Married |
Number of Children: (open text # only) |
☐No (BUSINESS RULE: SKIP TO MARITAL STATUS) |
☐Married |
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☐Unknown (BUSINESS RULE: SKIP TO MARITAL STATUS) |
☐Divorced/Not Remarried |
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☐Divorced/Remarried |
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Branch of Service: |
☐Widowed/Not Remarried |
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Air Force |
☐Widowed/Remarried |
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Army |
☐Separated |
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Coast Guard |
☐Living with Significant Other |
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Marine Corps |
☐ Domestic partnership |
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Navy |
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Agency incident or case number: ________________________________________________________ |
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Date of incident: |
Time of incident:
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Incident Occurred:
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Location of incident: ___________________________________________________________________________________ City County State Country |
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Type of location of incident:
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Manner of suicide or attempted suicide:
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Was this a murder/suicide or an attempted murder/suicide?
How many victims? ________
Type of victims (choose all that apply)
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Did the individual leave an explanation of the suicide or attempted suicide?
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What type of explanation was left behind?
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PART IV– CIRCUMSTANCES OF THE INCIDENT |
Incident:
Did the individual report - or was known to have experienced - any of the following within the last year? (check all that apply) |
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YES |
NO |
UNKNOWN |
Direct or Indirect involvement of an incident resulting in the death or serious injury of an individual |
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Experienced the death of a close colleague, friend, or family member |
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Survivors guilt |
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Threats of violence resulting from job performance results |
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Burnout/Secondary trauma collapse |
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Other (specify) |
Individual Self-Reporting:
Did the individual report they (is/was) experiencing from any of the following? (check all that apply) |
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YES |
NO |
UNKNOWN |
Post-traumatic stress disorder |
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Depression |
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Substance Use Disorder |
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Physical illness/injury impacting subject’s ability to perform in the capacity of the job. |
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Concern over impending retirement |
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Domestic violence |
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Chronic illness |
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Financial problems |
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Relationship problems |
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Compassion Fatigue |
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Vicarious Trauma |
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Other (specify) |
Agency Awareness:
Are you aware if the individual exhibited any mental health/warning signs prior to the incident? (check all that apply) |
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YES |
NO |
UNKNOWN |
Making threats to harm or kill themselves |
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Seeking abnormal access to drugs/weapons or other items that could cause harm |
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Excessively/consistently talking about death and/or dying |
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Expressing hopelessness, rage/anger, or anxiety |
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Engaging in risky behavior (reckless) |
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Increasing use of alcohol or drugs |
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Chronic/Increased absence from work |
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Increased work issues and/or complaints |
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Prior suicide attempts |
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Increased Social Isolation |
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No reports of any warning signs/None indicated to colleagues/agency |
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Other (specify) |
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Did the individual report a pending investigation against their employing agency? (BUSINESS RULE: APPLICABLE IF THE REPORTING AGENCY IS NOT THE EMPLOYING AGENCY)
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Is/was the individual(s) unit/office/division of employment under investigation? (BUSINESS RULE: APPLICABLE IF THE REPORTING AGENCY IS NOT THE EMPLOYING AGENCY)
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Was the individual the subject of a criminal investigation??
Has/is the individual (been/being) charged for a crime?
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Was the individual the subject of an administrative investigation?
Is/was the individual a witness in an investigation involving their colleague?
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Has the individual been disciplined (or pending discipline) for a violation of policy?
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Is/was the individual scheduled to stand trial, in civil, administrative, or criminal litigation, for an offense they allegedly committed?
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Would a guilty verdict preclude further service or employment by the individual?
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Was the individual on a promotional list?
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Was the individual recently denied a promotion or transfer?
Was the individual recently demoted or moved to another assignment?
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PART V WELLNESS POLICY AND TRAINING |
Does your agency have a formal well-being or resiliency program?
Yes
No
Unknown
Does your agency have a law enforcement competent formal well-being or resiliency program? (BUSINESS RULE: THIS QUESTION NEEDS TO BE APPLICABLE TO LEO AND CORRECTIONS – WILL NOT BE APPLICABLE TO LEGAL OR TELECOMMUNICATIONS)
Yes
No
Unknown
Does your agency provide training on secondary trauma, burnout, and suicide risk?
Yes
No
Unknown
Does your agency provide a peer-connection support program or platform?
Yes
No
Unknown
Does your agency provide training and opportunities for critical incident processing after significant traumatic work events?
Yes
No
Unknown
Does your agency provide mental health and counseling resources?
Yes
No
Unknown
Prepared by: ______________________________________________________ Date: ________/__________/__________
(mm/dd/yyyy)
Email address: ____________________________________________________ Telephone: _________________________
NOTE: If there are any questions concerning the completion of this form, contact the staff of the FBI UCR Program at 304‑625‑5370 or email at LESDC@fbi.gov.
Privacy Act Statement
Authority: The collection of this information is authorized under the Law Enforcement Suicide Data Collection Act, 34 U.S.C. § 50701; 28 U.S.C. § 534; 34 U.S.C. § 10211; 44 U.S.C. § 3101; and the general record keeping provision of the Administrative Procedures Act (5 U.S.C. § 301). Providing your contact information is voluntary; however, failure to provide your contact information may inhibit the FBI’s ability to verify or clarify information in your incident submission.
Principal Purpose: Providing your contact information allows the FBI to contact you with any clarifying questions regarding your submission. This allows the FBI to verify submitted information and ensure the accuracy of the data.
Routine Uses: All contact information will be maintained in accordance with the Privacy Act of 1974. Your information may be disclosed with your consent, and may be disclosed without your consent as permitted by all applicable routine uses as published in the Federal Register (FR), including the routine uses for The FBI Central Records System (JUSTICE/FBI-002), published at 63 FR 8659, 671 (Feb. 20, 1998) and amended at 66 FR 8425 (Jan. 31, 2001), 66 FR 17200 (Mar. 29, 2001), and 82 FR 24147 (May 25, 2017), and the FBI Online Collaboration Systems (JUSTICE/FBI-004), published at 82 FR 57291 (Dec. 4, 2017). Routine uses may include sharing information with other federal, state, local, tribal, or territorial law enforcement agencies.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Klingensmith, Lora L. (CJISD) (FBI) |
File Modified | 0000-00-00 |
File Created | 2021-12-01 |