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Subject Under Influence of: DrugsfAlcohoUOther
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O.G. Administrative Warning
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TO BE GIVEN TO ANY PERSON EXPOSED TOO.C.
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You have been contaminated with Oleoresin Capsicum (oq, a natural product derived fromcayenne'
peppers. I am going to treat you to reduce the discomfort you are feeling, as long as you cooperate.
OC is non-toxic and the effects will dissipate in a short time. The effects of OC may, nowever.rnask or
cover other medical conditions, induding overdoses or toxic levels of drugs like cocaine; ampnetamins,
barbiturates,
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3. I am going to ask you 5 questions for your own safety, Not answering my questions, withholding
infonnation, or giving false or misleading answers could delay medical. treatment and may seriously
jeopardize your health and safety.
4. Do you understand everything!
have told you?
Yes/No
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1. Ar
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Lqcation of each probe contact:
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Incident #:09-078962
On Scene? No
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Subject's Name:~'
Age: 21
DOB~
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Sex: Male Heighf:6'2" \"Jeight: 165 Race: Black Charge(s): C.S.C.S\ s" Degree
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1. Are you currently under the influence of Cocaine, Amphetamines, Barbiturates, PCp' r other
Hallucinogens, Heroine or other Opiates, or Alcohol?
'
,
Yes__
No __
If Yes, Which One(s)?
---,._'_-._.-_--_.
--:----:--:----::r--Refused to Answer:
Date/Time:
Initials
7-----
2.
Have you taken Cocaine, Amphetamines, Barbiturates, PCP or other allucinogens, Heroine or
other Opiates, or Alcohol in the LAST 8 HOURS?
Yes__
No __
' If Yes, WhichOne{s)? ------r----:--:------Refused to Answer: __
Date/Time:
.Initials
_
3.
----
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,5.
Do you have heart problems, lung prable s, diabetes, high blood pressure, or ny othermedical
condition?
Yes__
No __ , _ If Yes, W fch One(s)?
Refused to Answer:
DateiTime: -----'------:-in-=-it'a-:-:-s'\---.;,---, '\
Do you have any allergies?
Yes__
No
If Yes, Which One(s)?
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Date/Time:
Initials '
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Time, of Completion
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TO BE COMPLETED
Taser Serial #: ~
Cartridge Serial #(s): Unknown (lost ,during foot chase)
Number of Cartridges Fired: 1
Number of Probe Contacts: 2 in sweatshirt
Num,berofStun Contacts:
O
, Number of probes penetrating skin: O
, Laser sight activated only: - -Locatton of each probe contact: left arm of sweatshirt and left side of sweatshirt
.'Di~tanc between probes (in inches): Approx. 18
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No
.'Describe the subject's demeanor after the Taser was displayed ordeplayed: Continued to run.
Where were the probes disposed of? Placed in sharps container and t.o.t. Det.Sgt. Welyczko =-~.,.....~...,..,..
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Witnessed'
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TOBE COMPLETED
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Tasen Serlait(-,
Number of Cartridges. Fire _~=,=,I~~
Number of Stun Contacts: . . O
Laser sight activated only:
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Numbero;:~~::$(~~~:~~~~~~~~~~~~~'~_:~~n~~
Number of probes
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ou currently undr the influence of Cocaine, Amphetamine.s,Barl:itlirate.::.PCP
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rasr Us Report
. TO BE COMPLETED EV8R.YTIME THE TSER IS
;-'
Taser $erial#:
Number
It, .
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'Cartridge
ir
...
Serial#(s): -,,-J'::!I.f.:f::.:..2.:+:;:::'::~=I:::
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of Incident:_04/09/2009@1809_lncident#:_09-125637
Location of Incident:
Supervisor
Officer(s)
Notified:
D/Sgt Roberts
Deploying
On Scene? @No
Force:
Officer (if Different):
Interviewing/Filing
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Subject's
Jtltil~
Name: .....
Age: _29_
DOB::Ii~,-:
__
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Sex: _M_
Height: _5'10"_
Force UsedlDisplayed
Injuries
Weight: _184_
by Subject:
to Subject: _NONE,'"- __
Treated by:
Taser, Physical
contact
---'Hospital
OfBAICholfOther
..c-
Admission?:
list,
--_--
if Known: Marijuana,_---,-
__
~ '. Narrative Description of Incident (Include actions taken by both the Subject and the .:
Officer(s): On 04/091209 at approximately l809hrs the above g,fficers attempted to place the above'
subject under arrest for a NYS Parole warrant, when first approached the above subject did run into"
_was
pursuing when the above subject did slam the frn:t door on the arm of
-n continued to attempt to close the door. Once inside the above subject did continue to
resist his lawful arrest by swinging his arms and legs about, at which time a drive stun contact was
administered to the chest area. 'Due to the leather jacket the defendant was wearing th"Contact stun did
not have any effect on the subject. The subject then rolled over and an area near his buttock was exposed
and the subject was then given a stun contact to said area, subject did continue to resist by continuing to
swing his arms and legs. The subject was then given a second stun contact in the same area at which time
he complied and was able to be
While beina search at the scene the defendant began to
attempt to pull away from
nd come-along techniques were used to
walk the subject to a patrol unit for transport to CRU. Once the above subject was placed in the back seat
of Unit #501 he began to kick the door and window of said unit. The subject was then removed and
placed on the ground to be shackled for transport. No further incident occurred.
--
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raser Use Report
TO BE COMPLETED
Taser Serial #:~
Number of Cartridges Fired:
Number of Stun Contacts: _._3.
Laser sight activated only:
Location of each probe contacti ,
Distance
_
_
_
_
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(3) Programmed
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Incident #:09-136671
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--~-----------------------------------------------------~---.. _~
O.C. Administrative Warning
.
TO BE GIVEN TO ANY PERSON EXPOSED TO o.c.
1.. You have been contaminated with Oleoresin Capsicum (OC), a natural product derived from cayenne
. poppets. I alii gOiA=l:B-j]
eat 'Youto leduce tilO discOllifolt 'Youa~$
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2. OC is non-toxic and the effects will dissipate in a short time. The effects of OC may, however, mask or
cover other medical conditions, including overdoses or toxic levels of drugs like cocaine, amphetamines,
barbiturates, PCP and other hallucinogens, heroine and other opiates, or.alcohoi,
3.. I am going to ask you.5 questions for your own safety. Not answering my questions, withholding
!n;formation,or giving false or misleading answers could delay medical treatment and may seriously
jeopardize your health and safety.
4. Do you understand everything l have told you?
Yes/No
i
(over)
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Revised 3/20.04 /
_I
Pagelof2,1
Yes__
No __
Refused to. Answer:
Heroine or
_
_
Initials
PCP or other
"
/\
drugs>
_
Initials __
-_
4. Do you have heart problems, lung problems, diabetes, high blood pressure, or any other medical
ondition?
.
Yes__
Refused
..
No __
to. Answer: __
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Subject Under Influence of: Drugs/Alcohol/Other'
--'
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Narrative Description of Incident (Include actions taken by both the SubJect and the
'Officer(s):
On 05/01/2009 at approx 2053 hrs undersigned officer observed the defendant
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Upon
confrontation by the Police the defendant did run Westbound orr-SprinqSt, I pursued the
defendant and was able to grab his jacket from behind; when I did the defendant did flail
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five feet behind him when I observed him reaching into-the front of his waistband.
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from the taser. The suspect fell to the ground and continued to bury his hands further in
his waistband. Eventually I pried his hands out of his waistband and placed him in cuffs.
The defendant was not in possession of a weapon, he was attempting to destroy two
glassine baggies of heroin which were in his possession
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Questions
TO O.C.
Have you taken Cocaine, Amphetamines, arbiturates, PCP or other Hallucinogens, Heroine or
other Opiates, or Alcoho/ in th LAST 8 OURS?
Yes__ " No __
If Yes, Whi
One(s)?
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O.C. Administrative
Questions
Are you currently under the influence of Cocaine, Amphetamines, Barbiturates, PCPor other
Hallucinogens, Heroine or other Opiates, or Alcohol?
.
Yes__
No __
If Yes, Which One{s)?
_
Refused.to Answer:
Date/Time:
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_
1,
3,
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4, 00 you have heart problems, lung problems, diabetes, high blood pressure, or any other medical
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Yes__
No __
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TASERIS
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__
_
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iLength of Time for Electrical Current Application: programmed 5 sec. If long~rishorttf or more than
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05/05/2009
07:48
5184477895
PAGE 03/17
SSTA
DaylDatemme of incident:
#30,]
"'1-
.,lP c? 3~6
location of incident:
;':"j'.,:-
Supervisor Notified:
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Subject's
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Chacge(s):
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Hospital Admission?:
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O.C. Administrative
Questions
1-
PCP or other
'
,. ,,_."
..,-,
Initials ..,.-
HaVeyou taken Cocaine, Amphetamines, Barbiturates, PCP or other Hallocll1ogens, Herotnecr '
other Opiates, or Alcohol in the lAST 8 HOURS?
'
y~__
No ~_
fVes.,Whlcf1One(s)? ~
~~
_
Refused to Answer. __
oateJTime:
l"(tials
_
__
~...,.....
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Initi;ls _----...........,.~
;
4. 00 you have heart problems, lung problems. diabetes, high blood pressure, or any other medical
condition?
Yes__
No __
, Refusedto Answer:
No __
Initials _--'::__
. '-""
'\
Refused to Answer:
DatelTime:
a,
the undersigned
on thls
________________
:.Off'iCer
.,----:---,-,-,---o-
Signature
Witnessed
_
-
Intials
By
Time of.GQmpltioh
~~~~--~~~----------------~----------------~~~~--~~~
'~'
s Fired: _.-:..'
__
Cartridge
Sedal#(s): ,"1"Number of Probe contacts: -__
-~---"'-'p.p'-')__
_,_--_-Number of probes pen~tl'ati\ig 5I\io:..,.,.;("';:...)<--
-:-4.:.:;i.;:.:d..,::d..:.,Ir;...(
.r~
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Approximate
distance of probe launch: ...;,.....:
..:1::,.......I-;...-..;.{
Oid the application cause injury to thesubjei:t and/or others?
5 sec, If longer/~or
---:".--
Ye~
obesdis
ed of1
'1v
fYI,) ...
..v"1'
Ye~
P ,,'
'?
mor than
' ""-",,,
Describe the subjet's demeanor after the Taserwas displayed or deployed: J.kcf
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ew roth
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07:48
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. PAGE
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07:48
5184477895
SSTA
PAGE
15/17
~....
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Heroine '~r
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Initlals __
~_
Refusedto Answer:
Datemme:
------,---:I:-n-:-:tj::-a7s-:-\--.~
.
I, ~
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day
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Witnessed By
.,:;.,
.Time (lf~mpletion.
;'
.,
-.U~ngthof Time for Electrical Currant Application: () Progr.:lmmed 5 sec. 1f longer/shorteri'or more than
Qneappllcationf.explain total time frame Involved:
~----_
APproximate distancQ of probe launch: -:--:-----,--:-:--_:---:-~:___:;_:__:_:__-_
. Did the application cause injury to the subjet and/or others?
YeslNo If yes,
.-
expIa.":
YeslNa
sedaf?
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1. Ara you cUlUotJy uoor the influence of Co~lne, Amphet.amins, B~rbiturates. PCP or other
H;g(lulnQgen.s,Heroine or other Opiates, or Alcohol?
. - _. ...
.
Y$$__
No __
. If Yes, Which One(s}1
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Charge(s)::Mt1L
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Injunes toSubject:::J;,j~y
'11.:> c.oLl.-p.~ 'oN,
'l..A!';A'T%<'N,:' To /110"/,\(" Art.tA
Treated by: ~s;1)'L~~~Y
i""ICh. Hospital Admission?: _..L..Y;:::.~5",--_-,--..,.
Subject Under Influence of: DrugslAJcoholfOther
Ust, if Known: _+y~t$",-.
1
AP::ltI.ilJO.
.,..-
Narrativa Description of Incident (Include ~ons taken by both the Subject and th~. .,: ........
i
Officer(s):
.
. '.
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05/05/2009
07:48
PAGE
SSTA
5184477895
05/17
'-
O.c. Administrative
Questions
_.
2.
_
~
Refused
to Aoswl<1r.
__
pCP or other
Heroine
'or ..
OateITlme:~-------:-fn-:ti-:-:;'a~(:-s---i:
3.
-:--=--:-- __
Datamme: _~
Refused to Answer. ~_
.,.-_
Inmals
"
,
f,
4.
00 you have heart pflJblems, lung problems, dijabe~S, high blood pressure, Or oy other me<jical
condition?
'
Yes__
No __
If Yes, Which One{s)?
~~flJ.$e<:l. to AnsWer; __
Date!Tme~ --------:'~n-i:-~I:-a-I$-__-
!~
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the subject's
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demeanor
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05/89/2009
20:47
5184477895
SSTA
'PAGE
El1/02
Day/Daternme of incide
location of lncldent:
,':.
'
Supervisor Notified:
'---On Scene? ~o
Sm.Roberts
Subject'sName:_18iII~.
Sex:
-M.
Height: ~5'1~
Age:
_Weight: 145
18
Race:
008: ~
B
Charge,Cs):. PL 221.05..,....
-----:"-----_
..........._-----------_ ........ _-_...-..;..... ........ -..---.-.---'-'-~~"
Narrative Description of Incident (Include actions taken by both .theSubJect andthai:;<
Officer(s): After "um in off a roof andrunnin
awa fro several officers theab(J1fe
listdsub'eet failed taco
wi h multi redirect commands b
to l'et
down on the round or ou will be lasedI"
contim.ied ive loud and clear
.verbal commands to the sub "eel and then atte
ed to fire his laser at the sub "eel
owever the robes malfunctIoned.
then rabbed!he
subject's anns and forced him to the ground while continuing to give the verbar
commands" ut Our ha ds e Ind our back!" and ~~sto resistin !" The sub eel
refused o com I clutchln
both af his arms under his c est twhlch
oint
removed the tser cartrid e and delivered
o 2 drive stuns to the SlIb"eC's
. lower buttocks area. The subject flnally complied and placed his arms behind hls~ack
and was [llaced In handcuffs.
','
:, ".~
"C:I.,...,.~.
----------~--------------------------~~-------------------"
O.C. Administrative Warning
TO BE GIVEN TO ANY PERSON EXPOSED TO O.C.
You have been contaminated with Oleoresin Capsicum (OC), a natural product derived from cayelle .
peppers, I am going to trsat you t reduce the discomfort you are feeling, as long as you cooperat
2, OC is non-toxic and the effects wlll dissipate in a short time. The effects 'of OC may, however, ma~or
cover other medical conditions, including overdoses or toxic levels of drugs like cocaine, amphetanines,
barbiturates, PCP and other hallucinogens, heroine and other opiates, or alcohol.
3. .I am going to ask you 5 questlonsfor your own safety. Not answering my questions, withholding
7Jnformaton, or giving false or misleading answers could delay medical treatment and may serousf
. " Jeopardize your health and safety.
4,. ~o you understand ev'rything I have told you?
Yes/No
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B6/B9/20B9
20:47
"PAGE 02/02
SSTA
5184477896
O.C-,dmlnlstrat!y Questions
,
TO BE ASKED OF ANY PERSON EXPOS ED 'TO O.C.
t. Are you urrently under the Influence 01 Cocaine, Amphetamines, Sarbit':9; es, PCP Or other
: Hallucinogens, Heroine or other Opiates, or Alcohol?
Yes__
No __
ff Ves, Which One(s}?
Refused to Answer: __
DatelTIme:
.-..
~ __
~,.~.
__
-....,.L-----
------..,1'
2.
'3.
...:art problems,
condition?
Yes__ .. No __
, Refused to Answer:
.5.
niUats
.
.
Initials.
./.
/
If Yes, Wflic:hOne(s)'?
..i" Datel"l1~
OateITlme:
_
_
Inltla.ls
bo youYe.shave
any allergies? //..... ~f~
__ . No __
.lfYes WhiehOn(s)?
Refused to Answer: ~
Of
Inltla.ls
_
_
/i
--,'/~ __
I, ---:-
_--::-'-
---,'/~'
.'OfficerSI:natu:y
Witnessed .By
Time
i,"
.::.
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launch: -.;O!:!..!!ln~e:!.!hl:e:!.s~--:--__::---:-::___::_::____:_:__--__;_:__:
Did the application cause injury to the subject andlor others? YesINo ,If yes, expla.ln: ------
YesINo
Descr,ibe the subject's demeanor after the Taser was displayed or deployed:
Compliant
Jr
P~e2of2
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20:47
5184477895
SSTA
'PAGE
01/02
location of tncldent:
. .c"'On
Scene?~o
Subject's Name:
Sex: -M- . Height:. 5'1 t:-
Age: 18
eight= -.l45
Race:!l
008: ~
..,
. Charge(s): PL 221.05
'~'<f-~{;;
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,,;:T,';'::';'~(:\J
Narrative Description of Incident (Include actions taken by both the Subject and the "\ -: ::, 1.,' ~':.
Officer(s): After "urn in off a roof and runnin awa fro seve al officers the above
',
listd sub"ectfailed to 'co
wi h mul J le dlreot commands-b
to ~~et
down on the round or ou will be lasedi"
continued ive loud and clear
verbal commands to the sub"eet and then atte
ed to fire histaser atthesubOect
owever the robes malfunctioned.
then rabbedthe
subject s arms and forced him tofu.e ground while continuing to give tlJeverbal. ..
comma'nds, "put your hands gehlnd your back!" and '~stopresisting!"The
subject
.
refused o com I clutchln both of his arms under his c e
which oint
.
,
emoved the taser cartrid e and delivered
o 2 drive stuns to the sub"eo's
lower buttocks area. The sUblect1tQ.ally complied and placed his arms behind his back
aDd Wf!S glaced In handcuffs.
<
~~
.
:.,TO
t..: Yoo have bean contaminated with Oleoresin Capsicum (OC), a natural product derived from cayenne
peppers. Iam going to treat you to (educe the discomfort you are feeling,
2. OCis non-toxic and the effects wlll dissipate in a short time. The effects of OC may, however, mask or
cover other medical conditions, including overdoses or toxic levels of drugs like cocaine, amphetamines,
barbiturates, PCP and other hallucinogens, heroine and other opiates, or alcohol.
3. ,I am going to ask you 5 questons for your own safety. Not answering my questions, withholding
: Information, or giving false or misleading answers could 'delay medical treatment and may seriously
. '. ,jeoprdize your health and safety.
4.', ~o you understand eve'rything I have told you?
YeslNo
(over)
---
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5184477895
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2.
_--_-
__
Heroine or
other Hallucinogens,
~_
Initials..;..
-
Yes__
No__
If Y~' Which One(s)1
Refused to' Answer: __
DaterniJf:
"'>
Initiais
4. qo you have heart pro6ems, lung prOb_l~~, diabetes, high blood pressure, or any other medical
-..
condition?
Yes__ . No.__
. Refused to Aoswer:
/
If Yes, Wt'ich One(8)1
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.
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TO Bl: COMPLETED
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T.~er.Seflal #: ....:
pne appflcaton,
YesINo
DE!scr.lbe th~ subject's demeanor after toe Taser was displayed or deployed:
Compliant
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. Subject's Name:
: Age: 32 DOB:~.
. ~
Sex: Male Height: 6'1" Weight: 270 Race: Black Chalge(s)~CPCS\1st, Conspiracy f"'
.
"
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...
. On The above date during the culmination of a narcotcs investigation, the above
...defend. a.nt (.target).was to be arrested durin~.
sto. Th.e defendant. refused to.......
comply with emergency lights activated b~in
a marked polic vehicle,
and fled the Scene. Defendant was not pursued, The d~ferldant was then found to have ..
abandoned his vehicle in the area of
The Defendant was
- located in another vehicle as a passenger. Upon attemjJting to stop said vehicle, vehicle
began to flee,but then stopped. Upon stopping the defundant was observed in the front
passenger seat. I approached the front passenger sidelof vehicle and attempted to ope .....
thedoor, while the defendant was reaching down undet the seat. I struck thewindow and
ordered suspects to open the door. Doors were then u~(ocked, I believe by the driver,
. ,.and I opened the passenger side 'door, The defendant then exited the vehiJe and pushed
into the undersigned officer while swinging his right fist (punching) at the undersigned ..
"h~ed
then ..grabbe.d the defendant in the area of his waist and swept his legs
__
;.."'as..__arrived
to assist. Defendant landed on the groundfacefrrstand
- continued to fight by swinging his arms and elbows, and kicking trying to crawl away.
The undersigned De.tectjVe~stri~e
th~ def~ndant several time in ,the
.
shouldsr, arm and Side aS~ld
strlke tHe defendant several times with a
closed fist in the back and shOUlder area as additional Detectives arrived and all were .
attempting to handcuff defendant as he continued to resist and fight. _
then tased
the defendant (drive stunned) 4-6 times in the 'ow~r/m;dtlle back and the defendant
continued to fight and attempted to grab the taser. Defendant was finally handcuffed
requiring the utili2:ation of two sets of handcuffs, and cohtinued to kick and attempfto
crawl away requiring the undersigned,
to attempt to
hold him down.
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Taser Use
Rep@
lnglh of Time for Erectricar Cu"ont AppUcaijon; () p,gra"1""'. 5 soc. ~ rongortSwter,or more. than
OnOapplication,
tim. Inom. 'n""lvod: D.-rv. stunnel defen.an, 4-6 timos .t t.sa achSlun
due to defendants.></lr.intotar
fightIng andturniog.
Approximate distance of prob .. launch. NIA
Old the <lPPlicationcause injury to the $ubject andlor others?
Nb
Did the app/rcation of the Taser gain compliance from the subjef?
If yes, explain; No
No
O.scrib. the subj .. t'. deme,mor all.. th. T'''r was dis.r.yod oi deploYed: DI.nd'~1 wasr'fl(i.gI,~,
and O.tinu.~ to .act in.a "or.n. mann., and .... Is, a".. t and b.... m. m."'VOr.ntwh.n'djV.,~ti!nn<!<! .
Where were thaprObe$ disposedofiN/A
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Supervisor
:SGT. CUEHDON
Notifled:
.'.
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. Officer(s)'Depioying.
Force:
':. .~
'~.l!, "ewfng/FmngOfficer
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Injuries::to S~'lb-e-t:NONE
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TH:f~STAFE.HE COM~
..T..A-. F.F:.~STRAIN .
.- ~ FURTHER INCtnENT.--";.RESi~bNDEO.
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'TO BE elvEN TO ANY PERtlON EX~'EDTO
o.C.
:
.
1.. You haveb~~'r Co
.>a,te-dwith OeoreSnCa.PSCUm(OC);~liatural
prodl:lct dMy.~d from cayefIne
peppers, t amgbing to"tt.
reduce the discomfort YOLlIHeelng, as long S:y.u.G00perate,
'. 2. OC l.s.M9ri-toxic and the effctswlll.d.is
. in a short time. i:i:e effects of oc mly, hOW6\1o!f, maskor
.
cover tMr medicl Cbndrtlons., including oxi~,'. or toxic r~' Is of drugs like cocaii1;.~~mpl:letami.QeS,
barbltur-tE1S. PcP and other halluclf1ogef1s,heroine an
r 'ates, or alcohol.
3.
a~' goi.~g .~?as~ ou 5 questio~s for .your.own safety, Notan.., , : lSd. ~~,.q~estiOJ1s, withholding
rnfo.rmatron, or glvlryg false "Orf:l'lISleadrng':~m:swers could deI9y'j_1 ?-JlcaT1f''liJl!-nt and may serlousl.y
jeopardize your he'alth and' safety.'
;.:
______.
4, Do yOt! understand 'everything 'have-:t0'ld 'you? Yes!No ~
-----~.:
~..
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On Scene? No
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Subject's Name:.
Age: 35 DOB~m
Sex: M, Height: 5'08 "Veight: 185 Race: w Charge(sj: None
Force Used/Displayed by Subject: Throwing Kicks and Punches at ERstaff
Injuries to Subject: None
Treated by: St. Peters Hospital Admission?: ER
Subject Under Influence of: Drugs/Alcohol/Other List, if Known: Both
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O.C.
1. Are you currently under the influence of Cocaine, Amphetamines, Barb rates, PCP or other
Hallucinogens, Heroine or other Opiates, or Alcohol?
. Yes__
No __
If Yes, Which One(s)? ~
--:-~_--"'......-Refused to Answer:
DateITime:
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2.
Have you taken Cocaine, Amphetamines, Barbiturates, PCPor other Hallucinogens, Heroi
other Opiates, or Alcohol in the LAST 8 HOURS? .
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ne~pplication, explain total time frame involved: _-,------_..,.,.,..~--'-:-. -,.Approximateqistance
of probe launch:
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Did.the-appllcatlon cause injury to the subject and/or others? . Y?~
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TO BE GIVEN
You have been contaminated with Oleore$ir:i/p
, ,'~'" ~..~~\~'.,. J
peppers. I am going to treat you to redu~itP[ql
OC is non-toxic and the effects will dissi:p~~:imi;.i~l!
cover other medical conditions. ncludng;v~frdO'
barbiturates, PCP and other hallucinogen~l~H.rdl
I am going to ask you 5 questions for your,~As'
information, or giving false or misleading.a~sWif'
jeopardize your health and safety.
: ;UL:?El~jt
Do you understand everything I have.tolCi~Yo~;
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levels of drugs like cocaine, amphetamines,
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O.C. Admnistrali~lfb:tiestions
TO BE ASKED OF ANY PER,'
POSED TO O.C .
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1. Are you currently under the influence of Cocain'~" "'~hetamines, Barbiturates, PCP or other
Hallucinogens, Heroine or other Opiates, or Alcot1M?
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Yes__
No __
If Yes, Which One(s)?,-,'.:":":;~~!:!':-'
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Have you taken Cocaine, Amphetamines, BarbitIj' lEis, PCP or other Hallucinogens, Heroine or
other Opiates, or Alcohol in the LAST 8 HOURS?" ''U;'
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Witnessed By
Time of Completion,
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Taser Use~;R\"!~:"ort
TO BE COMPLETED EVERY\fHE
TASER IS USED
Taser Serial #: ~7
' ..
Cartridge", "li/")(S): !AJ.IIIII.I'IIIII.mID.III:,_,
Number of Cartridges Fired: _1__ ,
Number ofF.;t'Q'p:Contacts:_2,
,:I ..tl:"I';
Number of Stun Contacts:
0_. _
Number ofp~9bes penetrating skin:
La$ersight activated only: ~'j;!IJh:
.Locaton of each probe contact:
1-Left arm, second p~~bein shirt no penetration ~
Distance between probes (in inches): _' _4"-6"
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07/24/2009 23:00
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Dept.
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Day/Oate[ijme of Incidanti
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SGT GIPSON
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Have you taken Cocaine, Amphetamines, Barbiturates, PCP or other HaHi}cinogens, Heroine or
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Where were the probes disposed of? YES BY ALBANY MEDICAL CENTER
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Day/DatelTime of Inciden .
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On Se-ene? Yes
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Subject's Name:_T",,-a=z~(P..;;.i.;:...t
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Age: 15mo.'
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While acting as part of the entry team, execting a search warral1t;th
team encountered a vicious do . While movin throu h the a artment the do bit
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once in the u er torso and once in the shin.
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arrived on the scene and took custody of the dog. The/dog appeared to have no physical
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Initials __ -Do you normally take any illegal or prescription drugs>
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Initials
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Taser Serial ~
Cartridge Serial #(s--'
Number of C:rfrfci~d:
2
Number of Probe.Contacts: 2
Number of Stun Contacts: O number of probes penetrating skin: 0,----=..::.;
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Laser sight activated only: Laser/Llqht
Location of each probe contact: Left Buttocks
Distance between probes (in inches): 4 Inches
Length of Time for Electrical Current Application:
. one application, explain total time frame' involved:
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APD# 422
Officer.
or morethan
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11""14
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etami es, Barbiturates, PCP or' other Hallucinogens,
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8 HOURS?
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No __
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Refused to Answer: __
DatefTime:
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Initials -'-~.,L-~
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2.
ive Questions
RSON EXPOSED TO o.c.
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No __
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Refused to
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Date/Time:"
--'-'---'-+
Initial
.//
4, 00 you have
condition?
eart problems, lung problems, diabetes, high blood pre sure, or any other medical
/
Yes
No __
Re sed to Answer:
5.
00
If Yes, W!Jlh
One(s)?
--;':....-..
Date/Time:
-_.......,.L-7,.~/
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f, ---------------r"-----
the undersigned
on thisfo-
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Witness
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Day/D.atelTime.of !nci~.
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Age:25
Weight: lYO
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Charge(s):
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PL 2l...JO_20(Z)':>/
PL-2.O'S ;"30.
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Force Used/Displayed
by Subject:
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. .... ......1 :,=,~:;.::.'j":'..~+.~7T .......Q"'7?~,,:.-.-'., b""f.9'f':".i"":n,-,:?~. i"\
Injuries to Subject: --'-N..:uo..,Jo..J,;e=---'----'.,--...."....-..,---:'-:-....,.:-;.-f,- __
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Treated by: :---:-:=--__ --:--=-~_.r.::_7H:..:o:.::s:c.:pital
Admission?
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or Alcohol?
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the undersigned
---------------'---_
day of
on this
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Cartridge Serial#(s):
Number of Prob~ Contcts:
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Did the appliC4tion causeinjry
to the subject a'f<;f/or others?
Approximate
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Notified:
Sgt. Sesock
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Sex: _M_
PL 205.30
Name:
"iIIIh~~
Height:_S'7"_
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Age: ., _16_
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Weight: _150_
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#:09-429391_'
."On Scene? No
.F orce. Dpl:by'dh1';fh:~:Offieer'fch~cK~t;?H~r';:::";':":~
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hrs_lncident
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,
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Race: BLK_
Charge'(s): PL 140.10{a),.
Force Used/Displayed by Subject: Fleeing from officer and did not get on the ground and .
place hands behind back.
.
Injuries to Subject: Scrape to left hand,
Treated by:
Hospit.aIAdmission?:
,
SubjectUnderlnflunce
of: Drugs/Alcohol/Other
List, if Known: --'--'-~~~'---'--"7'"
'Na~rative Description of Incident (Include actions takenby~,?'~htheSubjectanqthe
Officer/s):
. ......>
.'
.
'.
",.On 11/19/09, approximately 1734 hours and at .
.
..... r: ' ... '
> '.observed'the
defendant, along with a group of black males, inside the interior,stairwlfofsaicj
apartment building on the north side of the building. An odor of marijuana was detectedi,'.'
in the stairwell where the defendant and others were congregated. The defendant along
.
with others were checked b~
and instructed to sit on the stairs of the. stoop
.
The defendant did then leaH~),fromthe stoop onto the sidewalk and fled eastboundorL.:
,
North Third Street. I yelledatthe
defendant to stop runninq and that he-was under arrest
and to stop running now. The-defendant did not comply with my commands and I
deployed the X-26 taser aiming at.the middle of the defendant's back. The taser'sprongs
did not make contact with the defendant and he continued to run southbound on.Walter
Street, then eastbound on North Second Street, northbound on Broadway and onto the
I yelled at the defendant to get on the ground and the
defendant did not comply. I swept.the defendant's leg and brought him to the grqund. I
placed my knee on the middle of the defendant's back and instructed him to place his
hands behind his back. The defendant eventually placed his hands behind his back and
was then handcuffed.
While at Central Booking, I observed that the defendant had a
scrape on his left hand. The defendantstated
he sustained the scrape when he fell as 'he
was runnin . The defendant stated he is fine and does not need any medical attention.
otified.
O.C. Administrative
Warning
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Administrative Questions
PCP or other
.
~
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2.. Have you taken Cocaine, Amphetamines; Barbiturates, PCP or other Hallqcinogens; Heroine or
other Opiates, or Alcohol in the LAST 8 HOURS?
.
. ,\
Yes__
No.__
If Yes, Which One(s)?
~
Refused to Answer:
DateITime:
Initials
_
3. 00 you normally take any illegal or prescriptiondrugs>
Yes__
No __
lf Yes, Which One(s)?_--Refused to Answer:
DateITime: _.
4.
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_
_
00 you have heart problems, lung problems, diabetes, high blood pressure, or any other medical
condition?
.
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__ :.....,....-'-__
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Date/Time: .,
-Initials_---,---
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Officer Signature
Witnessed By
Time of Completion
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_
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Length of Time for Electrical Current Application: () Programmed 5 sec. If longer/shorter, or more than
one application, explain total time frame involved: __~
_
Approximate distance of probe launch:
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Did the application of the Taser gain compliance from the subject?
NO
No
Describe the. subject's demeanor after the Taser was displayed or deployed:
_N/A.
_
Where were the probes disposed of? Turned over to Evidence Room
---....-,....".........,..,.-Rprting:ffcer:
APD # 422
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Subjet'sName:_
Age:_24_
Sex:M_
Height: 5'07_ Weght: _160_ Race: _Black_
DOB: ~
..
Charge(~): Dis Con, Resisting
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Narrative Description of Incident (Include actions taken by both the Subject and the
Officer(s) On 11/29/09 at 0356hrs the undersigned officer observed a (argefight.inthe
area of
while officers arrived and attempted tocleartheqroups
listed subject did disregard aUof the officers verbal commands toleavesaidarea.phd ...
then became very combative, and actively started fighting wit~
~
..in-which I observed the subject trying to strike the officers witfloseclfi$t,
as well as pushing/shoving and grabbing onto officers/waistband nearthe officers"
.
eq(Jipment. The undersigned officer did observe that the subject was out of control and
l risk to the officers and/or himself. The undersigned officer did give numerous
commands, and then did give three warnings of a taser deployment. Undersignedofficer
did deploy (1) five second cycle from the taser, and the subject did continue to fight with
the police. The undersigned officer did deploy an additional (1) three second cycle and
the subject was able to be placed into custody without any further incident. The subject
refused any medical attention on scene and at central booking.
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Hallucinogens, Heroine or other Opiates, or Alcohol?
Yes__
-No __
If Yes, Which One(5)?_'--_--.,..-_
Refused to Answer:
DatefTime:
Initials
_
or other
.:...
Have you taken Cocaine, Amphetamines, Barbiturates, PCP or other Hallucinogens, Heroine or
other Opiates, or Alcohol in the LAST 8 HOURS?
Yes__
No __
If Yes; Which One(s)?
_
Refused to Answer: __
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. Initials
_
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TaserSerlal #:
Sil..
Cartridge Serial #(s):'alllPJi!!LNI.Jf1.~er
of Cartridges Fired: _1___
Number of Probe Contacts: __ 2.
'----__
Ni.nber of Stun Contacts:
O
Number of probes penetrating skin: __ O-Clotlng Only__
.'L~$er, Sight activated only:
l..oc<iC>nofeach probe contact: Center Back and Lower back right side._
__
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'. Distane between probes (hinches): _1 Foot.
_
.:Lengtlfof Time for Electrical CUrrent Application: () Programmed 5 sec. If longer/shorter, or more than
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.,--_
_ .. __ (1)five second application; and additional (1) three second application_
Approximate distance of probe launch: _2 feet~
-=-Did the application cause injury to the subject and/or others? Yes(f) If yes, explain:
_
-=-0.
Didthe.application
of the Tasergaincompliance
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. Describe the subject's demeanor after the Taser was displayed or deployed:
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esistance Report
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I am going to ask you 5 questions for your own safety. Not answering my questions, withholding
information, or giving false or misleading answers could delay medical treatment and may seriously
jeopardize your health and safety.
.
Do you understand everything I have told you?
Yes/No
4.
.'/
Revised 3/2004.
(over)
Pag
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1. Are you currently under the influence of Cocaine, Amphetamines, Barbiturates, PCP,ar other
Hallucinogens, Heroine or other Opiates, or Alcohol?
Yes__
No __
If Yes, Which One(s)?
_
Refused to Answer: .
Date/Time:
Initials
_
2.
Have you taken Cocaine, Amphetamines, Barbiturates, PCP or of her Hallucinogens, Heroine or
other Opiates, or Alcohol in the LAST 8 HOURS?
Yes__
No __ -_ If Yes, Which One(s)?
~---.,-----'---Refused to Answer:
Date/Time:
Initiars __ .,--_
3.
_
Initials
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4.
Do yeu have heart problems, lung probiems, diabetes, high blood pressre, or any other medical
condition?
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Yes__
No __
Refused to Answer:
--:-~----Initials __
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Officer Signature
Witnessed By
.Time of Completion
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Ta'~erSerial #: ~
Cartridge Serial #(s): .Ytf"'IIIlJUn
Number of Cartridges Fired:
1
Number of Probe Contacts: _2.
_
Nmber of Stun Contacts:
Number of probes penetrating skin: _._2 __
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.'L~sersight activated only: __ 0__
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Location of each probe contact: _BOTH
CENTER CHESTrrORSO__
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Distance between probes (in inches): _12,
_
. Length of Time for Electrical Current Application:
( Programmed 5sec. If longer/shorter, or more than
one application, explain total time frame involved:
_
Approximate distance of probe launch: __ 2 foot.__ ---,Did the application cause injury to the subject and/or others?
---;;"""'
:-Yes~ o If yes, explain:
Did the application of the Taser gain compliance from the subject?
8NO
Describe the subject's demeanor after the Taser was displayed or deployed: _subject became very
cooperative after taser deployment
.
were the probes dispose
Reporti!1g Officer:
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APD#422
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