Injury Report Form

    Officer's Name:
    Badge Number:
    PR:
    District/Unit of Assignment:
    Best Contact Phone Number:
    Time and Date of Incident:
    Location of Incident:
    Description of Incident:
    Was Officer Injured?:
    YesNo

    If yes, which hospital?

    If admitted, what room number?

    Was Board Member or On-Call Rep Notified?:
    YesNo

    If yes, who was called?

    Was Attorney Notified?:
    YesNo

    If yes, who was called?

    Person Logging Above Information:
    Date and Time Notified:
    Notified By?:
    Police RadioOperations RoomDirectorOther
    Human :
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