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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.

:: General information Agency:
Officer:
Address:
Address 2:
City:
County:
State:
Contact Person:
Contact Phone:
Contact Fax:
Contact Email:
Agency Size: 1-99100-499500-9991000-49995000+
Agency Type: MunicipalSeriffStateFederalOther
Date of Incident: / /
Incident Start Time: AMPM
Incident End Time: AMPM
Incident Type:

Civil DisturbanceSuicidal SuspectViolent Suspect
BarricadeWarrant ServiceHostage Situation
Other

Suspect Name:
Suspect Weapon:
Suspect Age: Sex: MaleFemale
Suspect Height: Suspect Weight:
Suspect Race: Suspect Build: HeavyMuscledMediumThin
Suspect Wearing Heavy Clothing: YesNo
Describe Clothing: Suspenct Under Influence Drugs or Alcohol: YesNo

:: Incident Information: # of Less Lethal Rounds Fired: # of Rounds Hit
Medical Exam Performed: YesNo
Admitted for Hospital for Injures: YesNo
Admitted for Hospital for Psychiatric: YesNo
Attach Diagram of Scene:
Attach Photos of Injuries:

:: Incident Details

Weapons used:

SA-10nxTraining RoundsTAC700
Custom CarbineMarking RoundsFlash Launcher
Pepper RoundsAntiFreeze Rounds Other
Water Rounds

Distance Fired:
Injures Sustained:
Effectiveness:
Clean-Up: Wet Wipes at SceneBrush & 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.

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