STRANGULATION WORKSHEET REPORTING OFFICER & ID#: CASE #: Email(Required)Enter an email address to send a copy of the completed form to. VICTIM NAME:(Last, First, Middle) DOB: Month Day Year SEX: Male Female SUSPECT NAME:(Last, First, Middle) DOB: Month Day Year SEX: Male Female DISCUSS SEVERITY of EVENT and MEDICAL ATTENTION with VICTIM STRANGULATION INCIDENT QUESTIONSWhat did Suspect use to strangle you?Describe manner/method in detail in narrative Left Hand Right Hand Two Hands Forearm Knee/Foot Object or Ligature Positional Asphyxiation Describe Object or Ligature Describe Positional Asphyxiation Estimate how long the strangulation lasted:Minute(s) Seconds(s) Multiple Times: Yes No Yes: # of Times Estimate the amount of force the Suspect used to strangle you:(1 = weak, 10 = Very strong) 1 2 3 4 5 6 7 8 9 10 Narrative questions to consider: Note, remember to record the interview to include sound of voice, demeanor, etc. 1. How long have you been in a relationship with the Suspect? 2. Did the strangulation take place from the front or from behind? Describe. 3. Describe the Suspect’s emotional demeanor while strangling you. 4. Describe the Suspect’s face/expression during strangulation. 5. What did the Suspect say while strangling you? 6. Were you shaken, pushed into a wall or other furniture, floor or other surface, etc.? Was there property damage? Describe. 7. What else did the Suspect do while strangling you? 8. Could you breathe at all during the strangulation? 9. Were you able to speak during the strangulation? If “Yes,” what did you say? 10. What did you think was going to happen to you? Why? 11. What did you think about during the strangulation? 12. Did you do anything to attempt to physically stop the strangulation? If “Yes,” describe. What made the Suspect stop? 13. What did the Suspect say, if anything, after the strangulation? Demeanor? 14. Did anyone witness the strangulation? If “Yes,” who? 15. How many times did the Suspect strangle you? Did he use different methods? 16. Do you have any pain? Where? Any injuries? Did you urinate or defecate? Are you pregnant? (Review and include ‘Symptoms,’ below) 17. Has the Suspect strangled you on other occasions? If “Yes,” how many times? When? Witnesses or disclosures? Look for injuries behind the ears, all around the neck, under and on the chin, jaw, eyelids, shoulders and chest area. Scratches, ligature marks, bruising, small red spots, swelling? Look for Pattern Evidence; either impressions from Victim’s jewelry or that of the Suspect. Consider requesting a Strangulation exam, if indicated, and have Victim sign a Medical Release form.SYMPTOMS EXPERIENCED by VICTIMVision Changes: Tunnel DURING AFTER Vision Changes: Spots DURING AFTER Hearing Loss/Changes DURING AFTER Loss of Consciousness DURING AFTER Unable to Breathe DURING AFTER Difficulty Breathing DURING AFTER Rapid Breathing DURING AFTER Pain While Breathing DURING AFTER Shallow Breathing DURING AFTER Coughing DURING AFTER Coughing Blood DURING AFTER Nausea DURING AFTER Vomit/Dry Heaving DURING AFTER Dizziness DURING AFTER Headache DURING AFTER Feel Faint DURING AFTER Disorientation DURING AFTER Memory Loss DURING AFTER Painful to Speak DURING AFTER Raspy Voice DURING AFTER Hoarse Voice DURING AFTER Loss of Voice DURING AFTER Whisper Voice DURING AFTER Neck Pain/Tenderness DURING AFTER Trouble Swallowing DURING AFTER Pain Swallowing DURING AFTER Sore Throat DURING AFTER Urination DURING AFTER Defecation DURING AFTER Other DURING AFTER INVESTIGATION CONSIDERATIONS Photograph and document all injuries and physical evidence for BOTH parties If strangulation or suffocation occurred with an object, photograph and collect object Determine if jewelry was worn by either party, document, collect and look for pattern injuries Consider bail enhancement, complete Victim notification Investigate and document all potential areas of corroboration / or lack thereof (What did each party say occurred? Is there physical evidence on scene, in electronics, on a person to corroborate?) Consider a Pre-text telephone call to Suspect, screenshots of messages, recording voicemails, etc. Consider contacting a Domestic Violence advocate to address Victim needs Discuss with Supervision the availability of a Strangulation Forensic Exam Discuss with the Victim how dangerous strangulation can be and encourage medical treatment Law Enforcement ObservedMark Injuries Choose X Choose O Reset Selections FileMax. file size: 64 MB.Mark Injuries Choose X Choose O Reset Selections FileMax. file size: 64 MB.Mark Injuries Choose X Choose O Reset Selections FileMax. file size: 64 MB.Mark Injuries Choose X Choose O Reset Selections FileMax. file size: 64 MB.Mark Injuries Choose X Choose O FileMax. file size: 64 MB.Mark Injuries Choose X Choose O Reset Selections FileMax. file size: 64 MB.FACE Skin red / Flushed Red spots (Petechiae) Scratches / Abrasions Swelling Bruising Other Other: Describe EYES Red spots in eye(s) Left Right Red spots on eyelid(s) Left Right Blood in eyeball Eyelid(s) drooping Other Other: Describe NOSE Redness Red spots (Petechiae) Scratches / Abrasions Swelling Bleeding Other Other: Describe MOUTH Swollen lips Swollen tongue Bruise(s) Scratches / Abrasions Red spots in palate or on gums, etc. Other Other: Describe EARS Redness Red spots (Petechiae) Bleeding Bruising or Discoloration Swelling Red spots behind ear(s) Bruising behind ear(s) Other Other: Describe UNDER CHIN Redness Scratches / Abrasions Lacerations Bruises Linear marks / Half-moon marks (fingernail impressions) Other Other: Describe NECK Redness Scratches / Abrasions Bruises Linear / Half-moon marks (fingernail impressions) Ligature marks Red spots Swelling Other Other: Describe SHOULDERS Redness Scratches / Abrasions Lacerations Bruises Linear / Half-moon marks (fingernail impressions) Other Other: Describe HANDS, FINGERS, ARMS Redness Bruising Swelling Scratches / Abrasions Broken fingernails Other Other: Describe HEAD Lumps / Bumps Lacerations Scratches /Abrasions Hair missing Red spots on scalp (Petechiae) Other Other: Describe CHEST Redness Scratches / Abrasions Lacerations Bruises Linear / half-moon marks (fingernail impressions) Other Other: Describe Additional Observations: