UOF - Use of Force Supervisory Review

Date of Incident:
Time of Incident:
UOF #:
Incident Location:
Planned UOF Supervisor
Name:
Title:
Associate #:
Resident(s) Involved:(Add additional rows if necessary by selecting the last row and clicking the [+])
Staff Involved:
Name:
Title:
Associate #:
Name:
Title:
Associate #:
Name:
Title:
Associate #:
Name:
Title:
Associate #:(Add additional rows if necessary by selecting the last row and clicking the [+])
Others Involved:(Add additional rows if necessary by selecting the last row and clicking the [+])
What Force Category was used?
Category 1
Category 2
Category 3
Was medical attention needed- resident?
Yes:
No:
Comment:
Was medical attention needed-staff?
Yes:
No:
Comment:
Was the UOF recorded?
Yes:
No:
Comment:
Did all staff complete necessary reports?
Yes:
No:
Comment:
Narrative of Incident:
Reason for the Use of Force:
Shift Commander’s Notes and Comments
Shift CommanderAssociate #Date