Form Unnumbered National Use-of-Force Data Collection "National" Questio

National Use-of-Force Data Collection “National” Questionnaire

This questionnaire is being provided to allow for an easy review of questions and possible response values. The data collection itself, however, will use a web form.

National Use-of-Force Data Collection

The National Use-of-Force Data Collection is a component of the Uniform Crime Reporting Program that is used by law enforcement agencies to report a law enforcement use of force that results in a fatality, serious bodily injury to a person, or the discharge of a firearm at or in the direction of a person.

The definition of serious bodily injury is based in part on 18 United States Code 2246 (4) and means “bodily injury that involves a substantial risk of death, unconsciousness, protracted and obvious disfigurement, or protracted loss or impairment of the function of a bodily member, organ, or mental faculty.”

Multiple conditions can be indicated only if multiple subjects were involved.

Did this incident result in…? (Select all that apply.)

• The death of a person due to law enforcement use of force?

• The serious bodily injury of person due to law enforcement use of force?

• The discharge of a firearm by law enforcement at or in the direction of a person that did not otherwise result in death or serious bodily injury?

If you were able to select any of the above categories, please proceed to the Incident Information on the next page.

Incident Information

Agency ORI for reported incident (Required) ____________________

Q1. Agency Case Number (This number is requested to assist in tracking Incident Reports through the data collection. The original agency case number will only be available to agencies that have permission to access the data.)

___________________________________________

Q2. Date of the incident (mm/dd/yyyy) __________________

Q3. Local time of the incident (24-hour time HHMM) __________________

Q4. Location of the use-of-force incident

• Address (include street address/intersection, city, state, and ZIP Code)

______________________________________________________________________

______________________________________________________________________

• Latitude/longitude x-coordinate ________________ y-coordinate _______________

• Pending further investigation

• Unknown and is unlikely to ever be known

Q5. Location Type

• Abandoned/Condemned Structure

• Air/Bus/Train Terminal

• Amusement Park

• Arena/Stadium/Fairgrounds/Coliseum

• ATM (Automated Teller Machine) Separate from Bank

• Auto Dealership New/Used

• Bank/Savings and Loan

• Bar/Nightclub

• Camp/Campground

• Church/Synagogue/Temple/Mosque

• Commercial/Office Building

• Community Center

• Construction Site

• Convenience Store

• Daycare Facility

• Department/Discount Store

(list continued onto next page)

• Dock/Wharf/Freight/Modal Terminal

• Drug Store/Doctor’s Office/Hospital

• Farm Facility

• Field/Woods

• Gambling Facility/Casino/Race Track

• Government/Public Building

• Grocery/Supermarket

• Highway/Road/Alley/Street/Sidewalk

• Hotel/Motel

• Industrial Site

• Jail/Prison/Penitentiary/Corrections Facility

• Lake/Waterway/Beach

• Liquor Store

• Military Installation

• Park/Playground

• Parking/Drop Lot/Garage

• Rental Storage Facility

• Residence/Home

• Rest Area

• Restaurant

• School–College/University

• School–Elementary/Secondary

• Service/Gas Station

• Shelter–Mission/Homeless

• Shopping Mall

• Specialty Store

• Tribal Lands

• Other

• Pending further investigation

• Unknown and is unlikely to ever be known

Q6. What was the reason for initial contact between the subject(s) and the officer(s)?
(Please select one)

• Response to Unlawful or Suspicious Activity [Skip to Q6a and Q6b]

• Medical, Mental Health, or Welfare Assistance

• Routine Patrol other than Traffic Stop

• Traffic Stop

• Warrant Service

• Service of a Court Order

• Mass Demonstration

• Follow Up Investigation

• Other

• Pending further investigation

• Unknown and is unlikely to ever be known

Q6a. If the use of force was in response to a report or observation of “unlawful or suspicious activity,” what were the most serious observed offenses committed by the subject prior to or at the time of the incident?

Offense #1 _______________

Offense #2 _______________

Offense #3 _______________

• Pending further investigation

• Unknown/Not reported

Q6b. The National Incident-Based Reporting System (NIBRS) or local incident number of report detailing criminal incident information on the subject.

_______________________________________

• Pending further investigation

• Unknown/Not reported

Q7. Did the officer approach the subject(s)?

• Yes

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q8. Was this an ambush incident?

• Yes

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q9. Was a supervisor or a senior officer acting in a similar capacity present or consulted prior to when force was used in the incident?

• Yes

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q10. If the incident involved officers who used force from multiple law enforcement agencies, please provide the total number of other agencies involved.

Please provide ORIs and case numbers for the local use-of-force reports at the other agencies.

ORI CASE NUMBER

_______________________________ ____________________________

_______________________________ ____________________________

_______________________________ ____________________________

_______________________________ ____________________________

Subject Information

Please complete the following set of questions from this section for each individual who was subject to force that resulted in death, severe bodily injury, or a firearm discharge applied by officers from your agency in the course of this incident. Do not include any witnesses or bystanders who were not the subject of force applied by law enforcement. All data elements must have a valid response indicated in order to save the incident information.

Q11. Total number of subjects that died or received serious bodily injury as a result of a law enforcement use of force, including the discharge of a firearm at or in their direction ________

• Pending further investigation

• Unknown and is unlikely to ever be known

Subject Sequence Number ________

Q12. Sex of subject

• Male

• Female

• Pending further investigation

• Unknown/Not reported

Q13. Race and ethnicity of subject (select all that apply)

• Hispanic or Latino

• American Indian or Alaska Native

• Asian

• Black or African American

• Native Hawaiian or Other Pacific Islander

• White

• Pending further investigation

• Unknown/Not reported

Q14. Age of subject at time of incident

­­­­­­­­­­­________ to _______  Estimated

• Pending further investigation

• Unknown and is unlikely to ever be known

Q15. Height of subject (report actual or estimated range of values)

______ Feet ______ Inches to ______ Feet ______ Inches  Estimated

• Pending further investigation

• Unknown and is unlikely to ever be known

Q16. Weight of subject (report actual or estimated range of values) (lbs)

____ to _____  estimated

• Pending further investigation

• Unknown and is unlikely to ever be known

Q17. Did the subject’s behavior indicate to the officer that there could be drug impairment, alcohol impairment, or a mental condition involved?

• Yes [Go to Q19a]

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q17a. Please indicate which conditions apply (Select all that apply)

• Mental health condition

• Alcohol impairment

• Drug impairment

• Pending further investigation

• Unknown and is unlikely to ever be known

Q18. Was the threat by the subject(s) perceived by the officer(s) to be directed to the officer or to another party?

• Officer

• Another party

• Both the officer and others

• Pending further investigation

• Unknown and is unlikely to ever be known

Q19. At any time during the incident, was the subject armed or believed to be armed with a weapon (other than hands, fists, or feet)?

• Yes

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q20. Did the subject resist the officer(s)?

• Yes [Go to Q21a]

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q20a. What resistance or weapon was or was believed to be involved? (Select all that apply)

• Attempted to escape or flee from custody

• Resisted being handcuffed or arrested

• Barricading self

• Using a firearm against an officer or another

• Using another weapon (such as chemical agent, edged weapon, electronic control weapon, or blunt object) against an officer or another

• Using hands/fist/feet against an officer or another

• Displaying a weapon at an officer or another

• Directing a vehicle at an officer or another

• Intentionally spitting or bleeding on an officer

• Throwing an article or object at an officer

• Making verbal threats

• Failing to comply to verbal commands or other types of passive resistance

• Pending further investigation

• Unknown and is unlikely to ever be known

• None

Q21. Type(s) of force used by law enforcement connected to serious bodily injury or death of the subject (Select all that apply)

• Firearm

• Electronic control weapon (Taser®)

• Explosive device

• Chemical agent/Pepper or OC (oleoresin capsicum) spray

• Baton

• Impact projectile

• Blunt instrument/flashlight

• Hands/fists/feet

• Canine

• Other

• Pending further investigation

• Unknown and is unlikely to ever be known

Q22. What were the subject’s injuries received as a direct consequence of the use of force by law enforcement? (Select all that apply)

• Gunshot wound (including minor or grazing wounds)

• Unconsciousness (regardless of duration)

• Serious injury requiring medical intervention or hospitalization

• Death

• None

• Pending further investigation

• Unknown and is unlikely to ever be known

Officer Information

Please complete the following set of questions from this section for each officer who actually applied force that resulted in death, serious bodily injury, or discharged a firearm at or in the direction of a person in the course of this incident from your agency. Do not include any officers who were assisting or present; did not apply force; or applied force that did not meet the criteria as specified above. All data elements must have a valid response indicated in order to submit the incident information.

Q23. Number of officers who applied force during this incident ______

• Pending further investigation

• Unknown and is unlikely to ever be known

Q24. Number of officers from your agency who actually applied force during the incident _______

• Pending further investigation

• Unknown and is unlikely to ever be known

Officer Sequence Number __________

Q25. Sex of the officer

• Male

• Female

• Pending further investigation

• Unknown/Not reported

Q26. Race and ethnicity of the officer (select all that apply)

• Hispanic or Latino

• American Indian or Alaska Native

• Asian

• Black or African American

• Native Hawaiian or Other Pacific Islander

• White

• Pending further investigation

• Unknown/Not reported

Q27. Age of officer ____  Pending further investigation

Q28. Height of the officer _____ Feet _______ Inches  Pending further investigation

Q29. Weight of the officer ___________  Pending further investigation

Q30. Officer’s years of service as a law enforcement officer (total tenure)

___________

 Pending further investigation

Q31. Does the officer work full-time (160 or more hours per month)?

• Yes

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q32. Was the officer readily identifiable by clothing or insignia at the time of the incident?

• Yes

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q33. Was the officer on duty at the time of the incident?

• Yes

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q34. Did the officer discharge a firearm at or in the direction of a person during the incident?

• Yes

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q35. Was the officer injured during the incident that precipitated the use of force (serious or minor)?

• Yes [Go to Q35a and Q35b]

• No

• Pending further investigation

• Unknown and is unlikely to ever be known

Q35a. What were the officer’s injuries during the incident that precipitated the use of force (select all that apply)

• Gunshot wound (including minor or grazing wounds)

• Serious injury requiring medical intervention or hospitalization

• Other apparent minor injuries

• Unconsciousness

• Death

• Pending further investigation

• Unknown and is unlikely to ever be known

Q35b. NIBRS (or local) incident number of report detailing assault or homicide of law enforcement officer

_______________________________________

• Pending further investigation

• Unknown/Not reported