Albany
PoliceDept
SubjectResistanceReport
DaylDatefTime,OfIncidëntBcm.J1Jcrr'Inc,ident#:
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.OnScene?
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O.C.AdministrativeWarning
TOBEGIVENTOANYPERSONEXPOSEDTOO.C.1.YouhavebeencontaminatedwithOleoresinCapsicum(OC),anaturalproductderivedfromcayennepeppers.Iamgoingtotreatyoutoreducethediscomfortyouarefeeling,aslongasyoucooperate.
2.
OC.isnon-toxicandtheeffectswilldissipateinashorttime.TheeffectsofOCmay,however,maskorcoverothermedicalconditions,includingoverdoses-ortoxiclevelsofdrugslikecocaine,amphetamines,barbiturates,PCPandotherhallucinogens,heroineandotheropiates,oralcohol..3.
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amgoingtoaskyou5questionsforyourownsafety.Notansweringmyquestions,withholdinginformation,or.givingfalseormisleadinganswerscoulddelaymedicaltreatmentand
may
seriouslyjeopardizeyourhealthandsafety.
4.Doyou
understandeverythingIhave
taldyou?Yes!No(over)
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O.C.AdministrativeQuestions
TOBEASKEDOFANYPERSONEXPOSEDTOO.C.
1.
AreyoucurrentlyundertheinfluenceofCocaine,Amphetamines,Barbiturates,PCPorotherHallucinogens,HeroineorotherOpiates,orAlcohol?Yes__No__Ifyes,WhichOne(s)?--:--:-::---:-----.RefusedtoAnswer:Date/Time:Initials_
2.
HaveyoutakenCocaine,Amphetamines,Barbiturates,PCPorotherHallucinogens,Heroineor.otherOpiates,orAlcoholintheLAST8HOURS?Yes__No__IfYes,WhichOne(s}?'--_RefusedtoAnswer:Date/Tíme:Initials_
:3.
Doyounormallytakeanyillegalorprescrlptiondrugs>Yes__No_._IfYes,WhichOne(s)?--:-:-::--:--~RefusedtoAnswer:_-__Daterfimë:__,--_.,,--__Initials_
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4"Doyouhaveheartproblems,lungproblems,diabetes,highbloodpressure,oranyothermedicalcondition?Yes__No__IfYes,WhichOne(s)?
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RefusedtoAnswer:DateITime:Initials_-'-__
5.
Doyouhaveanyallergies?
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Yes__No__!fYes,WhichOne(s)?-:-~_:_-'-\~---RefusedtoAnswer:Dateffime:Initials
-------
l,~___,_---theundersignedofficer,havecompletedtheaboveIntervlew.wlth:_________________onthisdayof-
,20_.
OfficerSignatureWitnessed
By
TaserUseRepoli
,TOBECOMPLETEDEVERYTIMETHETASERISUSED
T~JerSerial#:CartridgeSerial#(s)::~ùrnberofCartridgesIre:NumberofProbeContacts:
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--:;:=;----:--:-_
NumberofStunContacts:Numberofprobespenétratinqskin:
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Laser,sightactivatedonly:--Lo(;at,lonofeachprobecontact:
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Qistèrhcebetweenprobes(ihinches):
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J\P.proximatedistanceofprobelaunch:
--:--::-'-"""'-...L.>-,.,'-'-I----7""'"'~:__-:-::-----,-
.Didtheapplicationcauseinjurytothesubjectand/orothers?YesrNoIfyes,explain:
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DidtheapplicationoftheTasergaincompliancefromthesubject?
~NO
Describethesubject'sdemeanoraftertheTaserwasdisplayedordeployed:--=.lÎ....:.;::C::...:_Whereweretheprobesdisposedof?
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APD#422
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