SOP_NUMBER: 209.04-att-1
TITLE: Use of Force Supplement Report
REFERENCE_CODE: IIB08-0001
DIVISION: Facilities
TOPIC_AREA: 209 Policy-Facilities Control/Discipline/Segregation
EFFECTIVE_DATE: 2021-02-18
WORD_COUNT: 113
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/105931
URL: https://gps.press/sop-data/209.04-att-1/

SUMMARY:
This form documents incidents involving use of force or assault by offenders within GDC facilities. Staff completing the form must describe the circumstances leading to the incident, specify the type and extent of force used (including any equipment or less lethal weapons), and indicate whether criminal prosecution should be considered. The completed report is retained in the offender's institutional file according to official retention schedules.

KEY_TOPICS: use of force, assault by offender, force incident report, less lethal weapons, officer safety, restraints, incident documentation, facility control, disciplinary action, offender conduct violation

ATTACHMENTS:
  1. Use of Force Supplement Report
     URL: https://gps.press/sop-data/209.04-att-1/
  2. Use of Force Incident Report
     URL: https://gps.press/sop-data/209.04-att-2/
  3. Use of Force Coversheet_Checklist
     URL: https://gps.press/sop-data/209.04-att-3/
  4. Conducted Electrical Weapon (Taser) Weekly Usage Report Example
     URL: https://gps.press/sop-data/209.04-att-4/
  5. Official Witness Statement Form
     URL: https://gps.press/sop-data/209.04-att-5/
  6. Restraint Chair Authorization Form
     URL: https://gps.press/sop-data/209.04-att-6/

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FULL TEXT:
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SOP 209.04
Attachment 1

2/18/21


GEORGIA DEPARTMENT OF CORRECTIONS

USE OF FORCE SUPPLEMENT REPORT
I. Identification:

Facility/Center_______________________________________________________________________________

Offender: ______________________________________GDC Number: ________________________

II. Officer's Report:

A. Circumstances Leading to Use of Force or Assault by Offender:

Time of Incident: _____________________________   Date of Incident: ________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

B. Type and Extent of Forceful Action (Include Equipment Employed, if any):

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

________________________________________________________________________________ ___________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Less Lethal Weapon Used: __________________________ Certification Date: ____________________________


C. Complete (if applicable) by staff member if assaulted by offender. Do you feel that the Offender(s)
should be considered for criminal prosecution?

() Yes () No

D. __________________________________________  ____________________________________________
Name Title
___________________________________________  ____________________________________________
Signature Date


Retention Schedule:  Upon completion, this form shall be retained in the offender’s institutional file and retained according
to the official retention schedule for that file.