PepperBall Technologies Incorporated | Law Enforcement & Corrections

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PepperBall® Use Reports
Use report statistics help law enforcement agencies in defending use-of-force against litigation, in evaluating force options, to define policy and procedure, and in making prudent and more informed decisions when purchasing new equipment. If you have had a use of PepperBall® equipment, we'd like to know. We will keep your individual use report and the specific information contained therein completely confidential. PepperBall is interested only in collecting statistical information. Your individual report will be compiled as a file for you to view and/or print, and will be sent in e-mail format to you for your agency's use. We all benefit by sharing this valuable information and PepperBall thanks you very much for taking the time.

All fields with * are required

:: General information

Agency:

Officer:

* Address:

Address 2:

* City:

* County:

State:

Zip/Postal Code:

* Contact Person:

* Contact Phone:

Contact Fax:

* Contact Email:

Agency Size:

1-99 100-499 1000-4999 5000+ 500-999

Agency Type:

Municipal Sheriff State Federal Other

Date of Incident:

/ /

Incident Start Time:

AM PM

Incident End Time:

AM PM

Incident Type:

Civil Disturbance Suicidal Suspect Violent Suspect
Barricade Warrant Service Hostage Situation
Other

Suspect Name:

Suspect Weapon:

Suspect Age:

Sex:

Male Female

Suspect Height:

Suspect Weight:

Suspect Race:

Suspect Build:

Heavy Muscled Medium Thin

Suspect Wearing Heavy Clothing:

Yes No

Describe Clothing:

Suspenct Under Influence Drugs or Alcohol:

Yes No

:: Incident Information

# of Less Lethal Rounds Fired:

# of Rounds Hit:

Medical Exam Performed:

Yes No

Admitted for Hospital for Injures:

Yes No

Admitted for Hospital for Psychiatric:

Yes No

Attach Diagram of Scene:

Attach Photos of Injuries:

:: Incident Details

Weapons used:

SA-10nx Training Rounds TAC700
Custom Carbine Marking Rounds Flash Launcher
Pepper Rounds AntiFreeze Rounds Water Rounds
Other

Distance Fired:

Injures Sustained:

Effectiveness:

Clean-Up:

Wet Wipes at Scene Brush & Spray clothing

Incident Synopsis:

Please double check this form for accuracy, this data will be submitted to the database and must be accurate to be useful. If you need any help filling out this form, contact us.

Click Submit When Complete.

PepperBall Technologies, Inc., does not warranty, and does not recommend the use of PepperBall projectiles in any launchers other than those sold by PepperBall Technologies, Incorporated. PepperBall projectiles are sold as a personal defense product and should only be used in accordance with state and local laws.