SOP_NUMBER: 209.04-att-3
TITLE: Use of Force Coversheet_Checklist
REFERENCE_CODE: IIB08-0001
WORD_COUNT: 198
URL: https://gps.press/sop-data/209.04-att-3/

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 3

2/18/21


**____________________________________________ Facility/Center**

**Use of Force/Serious Incident Report Coversheet**


**I.** **Offender Name_________________________________ Date: ____________________**

**II.** **Checklist:**

**1.** Use of Force………………………………………………………. Yes______ No _____Pending _____
2. Incident Report…………………………………………………… Yes______ No _____Pending _____
**3.** Supplemental Use of Force……………………………………….  Yes______ No _____Pending _____
**4.** Videotape…………………………………………………………. Yes ______ No_____ Pending _____
**5.** Photos……………………………………………………………... Yes ______No _____Pending _____
**6.** Witness statements from all involved………………………………Yes ______No _____Pending _____
**7.** Disciplinary Report filed…………………………………………...Yes ______No _____Pending _____
**8.** Medical Reports……………………………………………………Yes ______No _____Pending _____
**9.** Mental Health Report/Statements…………………………………. Yes______ No _____Pending _____
**10.** Chain of Evidence………………………………………………… Yes______ No _____Pending _____
**11.** Use of Weapons Report…………………………………………… Yes______ No _____Pending _____

**If pending is checked on any of the above, state the reason why:**

**III.** **Shift Supervisor: 1. Date submitted and forwarded to Captain: _____________________**

**2. Supervisor’s Signature:** **_________________________________________________________**

**IV.** **Captain/Chief of Security Review: 1. Date received: _________ 2. Date videotape reviewed: _______**

**3. Rating of Incident: Major:** **Serious:** **Minor:** **Unusual:**

**4. Comments:**

**5. Signature of Captain/Chief of Security:**

**V.** **Deputy Warden’s Review: 1. Date received** **2. Date videotape reviewed:**

**3. Comments:**

**4. Signature of Deputy Warden:**

**VI.** **Warden’s Review: 1. Date received: _____________ 2. Type and Forward: Y N  Hold in File: Y N**

**3. Comments:**

**4. Signature of Warden/Designee:**


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