CP-315

UNITED STATES CAPITOL POLICE (04/151

Page 1
_ _ __, USE OF FORCE REPORT

1. CCN • DUTYSTATUS
On-Duty ,0 Off..Duty □
4. EMPLOYEE'S NAME {Last, First, Ml)

8. SEX 9. RACE
rvo,JG □ Male O Female
10. SUBJECT'S DATE OF BIRTH 11. DATE OF INCIDENT 12. TIME OF INCIDENT
01 - ot, ,.. ::J. I Aff~ox. 1400 Jtor4
13. SUBJECT'S ADDRESS SUBJECT'S PHONE NUMBER
/V w IA-
15. RADIO RUN 16. TIME DISPATCHED ME CLEARED
Yes □ No -.,;, tv A
18. LEVEL OF FORCE USED (Please check all that may apply)
Compliance Techniques □ Defensive Tactics □ Deadly Force □

. MEANS OF FORCE USED

Empty-Hand Control Techniques Chemical Agent Spray
Withdrew Firearm From Holster Pointed Firearm at Individual
Firing of Firearm Baton
Other
---------
20. SUPERVISOR IN CHARGE OF THE SCENE HER USCP EMPLOYEES ON THE SCENE

(fFc,)

22. lNJURYTO SUBJECT 23. TRANSPORTED TO HOSPITAL (lfso, howl) · ·

1--------------1--------
No □ □ How_ _ _ _ _ _ __

25. TRANSPORTED TO HOSPITAL {If so, how?)

Yes □ No □ How
DISTRIBUTION

I. No Copies
2. Attach a CP-01 E to the original and forward through the Chain-of-Command to the Bureau Commander
within two (2) days
3. Original - signed by the Bureau Commander, forwarded to the Commander of the OPR

**EMPLOYEE MUST COMPLETE NARRATIVE ON THE FOLLOWING PAGE••

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CAPD_000003310
 CP-Jl'i
UNITED STATES CAPITOL POLICE 104/15)
P.ilge 2
USE OF FORCE REPORT

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Was the Watch Commander notified?

Were you involved in the incident? Yes □ No~

Were all injuries treated? Yes '3'° No □ Of no, please explain)

B~sed on your review of this Use Of Force, do the Yes~ No □

circumstances support the Use Of Force?

Do you recommend further investigation? Yes □ N

CAPD_000003311