StopTech, Ltd.
365 Industrial Drive, Harrison, OH 45030 USA
Phone: 800 537 0102; Fax: 513 202 0240
www.stopstick.com
Please fill in all fields and then click Submit Report button.
Agency Name:
Date of Offense:
Telephone:
E-mail Address:
Street:
City/State/Country/Zip:
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/
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Originating Agency:
Assisting Agencies:
Time Started
Time Ended:
Which device was used?
STOP STICK
Terminator
Piranha
Barracuda
Reason for pursuit?
Traffic
Drunk Driving
Warrant
Felony Vehicle
Other
Additional Charges:
Miles/Kilometers covered during chase:
-Select Unit-
Miles
Kilometers
MPH / Km/h when STOP STICKS were hit:
-Select Unit-
MPH
KPH
Miles/Kilometers covered after spiked:
-Select Unit-
Miles
Kilometers
Road Surface:
Asphalt
Concrete
Other
Number of tires flattened:
Which tires flattened?
R/Front
L/Front
R/Rear
L/Rear
STOP STICK deployed
Sleeved
Singularly
Locked Together
Make & model of target vehicle?
If pursuit is on Video, may we obtain a copy? Y /N.
Yes
No
Contact Person:
IMPORTANT - AFFIX SERIAL NUMBER STICKER(S) OF DAMAGED STOP STICK(S):
COMMENTS:
Deploying Agency:
Deploying Officer:
Case #:
Badge #:
Reporting Agency:
Reporting Officer: