REPULS Field Use/Deployment Report

Details of Individual(s) Sprayed:

How many of each gender was sprayed?
Male(s) Female(s)

Please list out the age(s) of those sprayed (ex. "26, 31, 34, etc")

Location of REPULS Deployment: Example outside, mobile home, house, hallway, school, restaurant, bus, hospital etc.

Weather conditions:
ClearCloudyWindyRainyStill

Temperature

Was the subject under the influence of drugs/alcohol?
YesNoUnknown

Was the subject suffering from a mental illness?
YesNoUnknown

Nature of the contact/arrest that caused you to utilize REPULS
UncooperativePassive ResistanceActive Resistance AggressiveSuspect Fleeing

Subject Status
ArrestedReleasedMental Health HoldHospitalizedOther (Please Describe)

Was REPULS effective?
YesNo

What was the subject’s reaction to the REPULS deployment?

Was other use of force necessary?
Yes or No - If so, what?
YesNo

Did you experience any problems deploying REPULS?
If Yes please explain:
YesNo

Did REPULS cause injury?
If Yes please describe the injury:
YesNo

Approximately how far from the subject was REPULS sprayed? (in ft)

How many times was REPULS deployed/used?
1 deployment2 deployments3 deployments4 deployments5 deployments6 deployments or more

How long did the REPULS burst last?:

How long after REPULS was used did the mitigation process start:

Please provide a brief summary or circumstances that caused you to deploy REPULS:

Was the incident captured on BWC?
YesNo

Please provide any additional information that may help us improve REPULS: