Timmy TEST

CUSTODIAL DEATH REPORT Agency Information ORIGINAL CDR Number: 18-1104-C Version Type: VERSION 11/9/2018 11:18 Report Date: Status: Submitted AM Agency/Facility Information Agency Name: Test CDR Agency Agency Address: 123 Main St Agency City: Austin Agency State: TX Agency Zip: 78704 Director Information Director Salutation: Chief Director First Name: Donna Director Middle Name: Director Last Name: Jumper Reporter Name: Sara Tester Reporter Email: [email protected] Decedent Information Custodial Death Report :: Page 1 of 6 --- PAGE BREAK --- Identity of Deceased First Name: Timmy Middle Name: Last Name: TEST Suffix: Date of Birth: 11/9/1980 Sex: Male Race: Anglo or White Age At Time Of Death: 38 Date/Time of Custody (arrest, incarceration) (mm/dd/yyyy hh:mm AM/PM): Date/Time of Custody or 11/8/2018 12:01 Incident: AM Date/Time of Death (mm/dd/yyyy hh:mm AM/PM): Death Date and Time: 11/9/2018 9:00 AM Manner / Cause of Death Has a medical examiner or coroner conducted an evaluation to determine a cause of death? Medical Examiner/Coroner Yes, results are Evaluation?: available What was the manner of death? (select only one) Manner of Death: Accidental Custodial Death Report :: Page 2 of 6 --- PAGE BREAK --- Medical Cause of Death: Medical Cause of Death: TEST Had the decedent been receiving treatment for the medical condition that caused the death after admission to your jail's jurisdiction? Medical Treatment: No If death was an accident, homicide or suicide, who caused the death? Who caused the death?: Decedent If a weapon caused the death, what type of weapon caused the death? (Hold CTRL to select all that apply) Type of weapon that caused Rifle/shotgun death?: Was the cause of death the result of a pre-existing medical condition or did the decedent develop the condition after admission? Deceased Pre existing medical developed condition condition?: after admission If death was an accident, homicide or suicide, what was the means of death? Baton / blunt Means of Death: instrument Location / Custody Information Where did the event causing the death occur? Custodial Death Report :: Page 3 of 6 --- PAGE BREAK --- Street Address: 123 Main St. City: Test County: Anderson Zip: 11123 What location category best describes where the event causing the death occurred? Location Category: Residence/Home What type of custody/facility was the Decedent in at the time of death: Police Custody Type of Custody: (pre-booking) Specific type of custody/facility: Specific Type of Custody/Facility: Custody of Law Enforcement Personnel during/fleeing arrest What was the time and date of the deceased's entry into the law enforcement facility where the death occurred (mm/dd/yyyy hh:mm AM/PM): Entry Date Time: 11/8/2018 1:00 AM Where did the death occur? Death Location: Scene of incident General Information Did any other law enforcement agencies respond to calls for service related to this incident? Other Agencies Respond?: Yes Custodial Death Report :: Page 4 of 6 --- PAGE BREAK --- What were the most serious offense(s) with which the deceased was (or would have been) charged with at the time of death? Offense 1: 123 Offense 2: Offense 3: Were the Charges:: Filed What were the types of charges or reason for contact? (Hold CTRL to select all that apply) Violent Crime Type of Offense: Against Persons At any time during the incident and/or entry into the law enforcement facility, did the decedent display or use a weapon? Decedent display/use of No weapons: At any time during the incident and/or entry into the law enforcement facility, did the decedent: Attempt to Injure Others?: No At any time during the incident and/or entry into the law enforcement facility, did the decedent: Appear intoxicated (alcohol or No Make suicidal statements?: No drugs): Exhibit any mental health No Exhibit any medical problems?: No problems?: At any time during the incident and/or entry into the law enforcement facility, did the decedent: Barricade self or initiate Resist being handcuffed or No No standoff?: arrested?: Custodial Death Report :: Page 5 of 6 --- PAGE BREAK --- Physically attempt/assault No Gain possession of officer's No officer(s): weapon: Verbally threaten other(s) Escape or attempt to No No including law: escape/flee custody: Attempt gain possession No officer's weapon: Was the deceased under restraint in the time leading up to the death or the events causing the death? Under Restraint: No Summary of Incident Summary of How the Death Occurred: (max. 30,000 characters) Summary: test Custodial Death Report :: Page 6 of 6