UOF - Use of Force Administrative Review

Date of Report:
Supervisor:
UOF Case #:
Incident Location:
Date of Incident:
Resident/Client(s) Involved:(Add additional rows if necessary by selecting the last row and clicking the [+])
Shift Commander or Supervisor:
Name:
Title:
Associate #:
Which Force Category was used?
Category 1
Category 2
Category 3
Was the UOF personally observed?
Yes:
No:
Comment:
Were all incident-related reports reviewed?
Yes:
No:
Comment:
Were all videos of the UOF reviewed?
Yes:
No:
Comment:
Was a follow-up check with the subject completed?
Yes:
No:
If yes, summarize in general terms:
Did the subject provide a statement?
Yes:
No:
If yes, add the statement:
Was medical care given and who provided care?
Yes:
No:
If yes, describe in general terms:
If applicable, was afollow-up medical check completed? (Prisons only)
Yes:
No:
If yes, describe in general terms:
If applicable, was the follow-up mental health check completed? (Prisons only)
Yes:
No:
If yes, describe in general terms:
Shift Commander or Supervisor comments:
Follow-up check completed by the next shift commander within eight (8) hours of the incident (Prisons Only)
Shift Commander or Supervisor:
Name:
Title:
Associate #:
Did the subject provide a statement?
Yes:
No:
If yes, summarize the statement:
If applicable, was a follow-up medical check completed? (Prisons only)
Yes:
No:

If yes, describe in general terms:
If applicable, was the follow-up mental health check completed? (Prisons only)
Yes:
No:
If yes, describe in general terms:
Shift Commander comments:
Deputy warden’s (or captain’s) face-to-face assessment conducted next business day (Prisons only)
Deputy warden or captain
Name:
Title:
Date:
Did the subject provide a statement?
Yes:
No:
If yes, summarize the statement:
Comments:
Warden
Name:
Title:
Date:
Comments: