HomeMy WebLinkAbout(Reviewed & Redacted) 1809p-0205 taser report form 1.1 Palm Springs Police Department -114
7:.r1 TASER Device Form
BACKGROUND INFORMATION:
Date of Occurrence: 09/02/2018
Location: .
Officers Involved: Officer Crampton
SUSPECT INFORMATION:
Time of Occurrence: 0110 DR#: 1809P-0205
Name: Marvin Blake Highest Booking Charge: Misd:0 Fel:0
Charges: 69 PCx2,148(a)(1) PCx2, 21310 PC, 245c PC, 243b PC
Age: 31 ®Male OFemale Height: 511 Weight: 203
Clothing Description: Blue T-Shirt, Grey Shorts
Under the Influence: 12Yes EN° What: Unknown
TASER INFORMATION:
TASER Make/Model: X26 TASER Serial #:
TASER ACTIVATIONS:
Was a verbal warning given prior to TASER activation? El Yes ON°
Did the Ddisplay, q laser, or ID arc deter the subject and allow officer to gain compliance? ElYes EiNo
Type of Mode Used: ®Probe 0Drive-Stun DBoth Total Number of Activations: One
Duration of Cycle: #1: 6 Seconds #2: 5 Seconds #3: #4: Additional:
Duration Between Applications: #1-#2: 7 Seconds #2-#3: #3-#4: Additional:
Duration Subject Rectd Applications: #1: 0 Seconds #2: 0 Seconds #3: #4: Additional:
More than one cartridge Discharged? Eyes ®No How many?
Cartridge #1 / Serial #:
Darts Penetrate Skin? El Yes ®No Number: at 02 Distance Fired: Approx. 5 foot Spread: Unknown
Cartridge #2 / Serial #:
Darts Penetrate Skin? 0Yes 0No Number: 01 02 Distance Fired: Spread:
Was TASER Effective? Oyes No
Did TASER immobilize suspect? OYes No Did the TASER bring suspect to the ground? DYes No
Operational defects, or need to inspect TASER? OYes No
Additional Notes:
INJURIES TO SUBJECT:
Injuries: 0 None 0Complaint of Pain Only EIVisible Injuries ODarl Removal Only
Describe Injuries:
MEDICAL TREATMENT TO SUBJECT:
Location of Treatment: DRMC • PSPD 00n-Scene ■ Other:
Hospitalized? Oyes No
Description of Treatment: First Aid
Person who Removed Darts: N/A
OK to Book Received? NYes ONo Suspect Booked: ®Banning EICite Release
Treated By: ER Staff
TASER Form (9-13.15) Refer to Policy Section 309 for Reporting Guidelines Page 1 of 2
INJURIES TO OFFICER:
Injuries: ■ None ❑Complaint of Pain Only ®Visible Injuries
Describe Injuries: Scratches to face,neck, left and right arms, and swollen right jaw.
MEDICAL TREATMENT TO OFFICER:
Location of Treatment: IN DRMC ❑PSPD ❑On-Scene ®Other: none
Hospitalized? ❑Yes ®No Treated By:
Description of Treatment:
PHOTOGRAPHS:
Photographs of Injuries Taken? OYes ❑No How Many? 54 Date Taken: 09/02/18
Description of what is being depicted in photographs: injuries and overall of Officer
TASER PROBESIDRIVE-STUN LOCATIONS (Use Ink Pen on Form After Printing):
X = Probe
D = Drive-Stun
FRONT
Description of Where Missed Probes Went: Probes into upper torso
DOCUMENTATION:
BACK
Witnesses (Officers & Civilians): Officer Gilbert
Activation history reviewed and attached? ®Yes ❑No if not, why?
Supervisor Notified of TASER Deployment? ®Yes ❑No Supervisor Name: N. Andre
Name ofperson preparing this form: M. Crampton ID #: 15642 Date: 09102/18
TASER Form (9-13-15) Refer to Policy Section 309 for Reporting Guidelines Page 2 of 2