BolaWrap Field Use Report
The purpose of this report is to gather field use data to help us to improve our products and our training.  All agency information will be confidential unless permission is expressly requested by Wrap and granted by the submitting agency.

Aggregate information will be shared with other agencies to enhance successful deployments and training programs.

Please complete in as much detail as possible.
Sign in to Google to save your progress. Learn more
Reporting Officer's Name *
Agency *
Email *
Phone *
Is this the same person who deployed the BolaWrap? *
Date of Use *
MM
/
DD
/
YYYY
Time of Use *
Time
:
Age of Subject *
Gender of Subject *
Was the subject under the influence of drugs/alcohol? *
Was the subject suffering from a mental illness? *
Nature of the contact/arrest that caused you to utilize the BolaWrap (i.e., uncooperative, aggressive, suspect fleeing, etc.): *
Disposition of the subject: *
Required
Was the BolaWrap effective? *
Please explain: *
What was the subjects reaction to the deployment? *
Was additional force necessary? If so, what? *
Did you experience any problems deploying the BolaWrap? *
If yes, please explain: *
Did the BolaWrap cause an injury to anyone? *
If yes, please describe the injury: *
Approximately how far from the subject was the BolaWrap deployed?   *
How many cartridges were deployed at the subject? *
What area(s) were targeted? *
Required
Did the hooks penetrate the subject’s: *
Required
If applicable, how was the tether removed from the subject? *
Please provide as much detail about the incident relative to the BolaWrap deployment as possible.  Any information that may help us improve the product or the training is greatly appreciated. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms