TASER® Unintentional
Discharge/Injury Report
NOTE: This form must be completed by the Master Instructor for ANY injury to instructors,
students, or observers received during the conduct of a TASER International instructor
course. Contact the TASER International Training Coordinator at 1-800-978-2737 and
report the incident as soon as possible, then fax this report to 480-905-2034 Attention:
Training Coordinator.
Master Instructor Name:
Date of Incident:
Class Location:
Name of Injured Party:
Injury Occurred During (Circle One):
Classroom

Voluntary Exposure

Firing Drills

Scenarios

Type of Injury:
Specific Points of Probe Impact (If Applicable):
Describe in detail how the injury happened. Please be as detailed as possible and use the
back of this form if necessary:

What treatment, if any was provided in class, or was any outside medical attention
received:

How can this type of injury be prevented in the future?

List witnesses to the incident on the back of this form.
TR-FORM-INCID-001 Rev: A
June 1, 2007
Page: 1 of 1
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