HomeMy WebLinkAbout(Reviewed & Redacted) 1809p-0205 taser report form 2Palm Springs Police Department
TASER Device Form
BACKGROUND INFORMATION:
Date of Occurrence: 09/02/2018
Location: .
Officers Involved: Officer Gilbert
SUSPECT INFORMATION:
Time of Occurrence: 0110 DR#: 1809P-0205
Name: Marvin Blake Highest Booking Charge: Misd:0 FeI:0
Charges: 69 PCx2,148(a)(1) PCx2, 21310 PC, 245c PC, 243b PC
Age: 31 ❑Male ❑Female Height: 511 Weight: 203
Clothing Description: Blue T-Shirt, Grey Shorts
Under the Influence: ❑Yes ❑No What: Unknown
TASER INFORMATION:
TASER Make/Model: X26 TASER Serial #:
TASER ACTIVATIONS:
Was a verbal warning given prior to TASER activation? EYes ❑No
Did the El display, q laser, or q arc deter the subject and allow officer to gain compliance? 0 Yes ONG
Type of Mode Used: E Probe ❑Drive-Stun ❑Both Total Number of Activations: One
Duration of Cycle: #1: 5 Seconds #2: #3: #4: Additional:
Duration Between Applications: #142: #243: #344: Additional:
Duration Subject Recid Applications: #1: 0 Seconds #2: #3: #4: Additional:
More than one cartridge Discharged? ❑Yes 10No How many?
Cartridge #1 / Serial #:
Darts Penetrate Skin? EYes El No Number: Ei ❑2 Distance Fired: Apprpx. 5 feet Spread: Unknown
Cartridge #2 / Seriat #:
Darts Penetrate Skin? q Yes 0Mo Number: q i ❑2 Distance Fired: Spread:
Was TASER Effective? ❑yes EgNo
Did TASER immobilize suspect? ❑Yes E No Did the TASER bring suspect to the ground? ❑yes 1:ENo
Operational defects, or need to inspect TASER? EYes ❑No
Additional Notes: Taser was broken during struggle.
INJURIES TO SUBJECT:
Injuries: ®None
Describe Injuries:
Complaint of Pain Only ❑Visible Injuries ❑Dart Removal Only
MEDICAL TREATMENT TO SUBJECT:
Location of Treatment: ODRMC MPSPD On-Scene 0 Other:
Hospitalized? ❑Yes E No
Description of Treatment: First Aid
Person who Removed Darts: N/A
OK to Book Received? EYes ON° Suspect Booked: ❑Banning ❑Indio ❑Cite Release
Treated By:
...
TASER Form (9-13.15) Refer to Policy Section 309 for Reporting Guidelines Page 1 of 2
INJURIES TO OFFICER:
Injuries: ONone ElComplaint of Pain Only ®Visible Injuries
Describe Injuries: Scratches to face and neck, swollen left and right jaw.
MEDICAL TREATMENT TO OFFICER:
Location of Treatment: EIDRMC EIPSPD DOn-Scene ®Other: none
Hospitalized? DYes No Treated By:
Description of Treatment:
PHOTOGRAPHS:
Photographs of Injuries Taken? ®Yes ON° How Many? 54 Date Taken: 09/02/18
Description of what is being depicted in photographs: injuries and overall of Officer
TASER PROBES/DRIVE-STUN LOCATIONS (Use Ink Pen on Form After Printing):
X = Probe
D = Drive-Stun
FRONT
X 1.A0,31 -)0LJA..)-t_
BACK
Description of Where Missed Probes Went: One probe into right abdomin area, other unknown
DOCUMENTATION:
Witnesses (Officers & Civilians): Officer Crampton
Activation history reviewed and attached? ®Yes ONo If not, why?
Supervisor Notified of TASER Deployment? ElYes IDNo Supervisor Name: N. Andre
Name of person preparing this form: T. Gilbert ID #: 16058 Date: 09(02/18
TASER Form (9-13-15) Refer to Policy Section 309 for Reporting Guidelines Page 2 of 2