Police Blotter Information Report – Sample

Name of Individual Arrested: _________________________________________________________________________________________

Age of Individual Arrested: _____________________________ Sex of Individual Arrested: ______________________________

Date of Incident: _______________________________________________________________________________________________________

Time of Incident: ______________________________________________________________________________________________________

Location of Incident: ___________________________________________________________________________________________________

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Name of Arresting Officer: ____________________________________________________________________________________________

Summary of Incident: __________________________________________________________________________________________________

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Charge(s) Against Arrested Individual: ______________________________________________________________________________

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Additional Information: _______________________________________________________________________________________________

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Pennsylvania’s Right-to-Know Law and the Criminal History Record Information Act (CHRIA) are both clear that
police blotter information – i.e., “A chronological listing of arrests, usually documented contemporaneous with the
incident, which may include, but is not limited to, the name and address of the individual charged and the alleged
offenses.” – is public. This sample form, prepared by the Office of Open Records, is designed to help law
enforcement agencies meet those requirements. It also includes additional information which is commonly
released. More information is available on the OOR’s website, www.openrecords.pa.gov