CRITICAL INCIDENT SURVEY

Critical Incident / Officer Involved Shooting Survey

Demographic information:
Age:		Years on the force:
Sex:		Total number of shootings in which you have been involved:
Rank		How many were officer involved shootings?
Zip Code:

1) Please briefly describe your critical incident.
Year of incident		Age at Time of the Incident
Years with Agency		At Time of Incident

2) During the incident, did you experience: (Please check the appropriate box)
Time Distortion:	Time slowed down	Time sped up
Visual Distortion:	Tunnel vision	Heightened detail
Auditory Distortion:	Sound intensified	Sound diminished
3) Did you experience any memory loss of parts of the incident? Please describe:

4) The department procedures following my incident left me feeling:
(Please check the appropriate box)

	Very Negative		Somewhat Negative		Neutral
	Somewhat Positive		Very Positive

5) How were you treated by peers afterwards?

	No Support		Little Support		Some Support
	Mostly Supportive		Very Supportive

6) How were you treated by investigators afterwards?

	No Support		Little Support		Some Support
	Mostly Supportive		Very Supportive

7) How were you treated by supervisors afterwards?

	No Support		Little Support		Some Support
	Mostly Supportive		Very Supportive

8) How were you treated afterwards by administrators?

	No Support		Little Support		Some Support
	Mostly Supportive		Very Supportive

9) I had a debriefing with a Mental Health Professional that was:

	Not at all helpful		Not very helpful		Neutral
	Somewhat helpful		Helpful

10) I had a talk with a Peer Support Team Member that was:

	Not at all helpful		Not very helpful		Neutral
	Somewhat helpful		Helpful

11) I had a talk with a chaplain that was:

	Not at all helpful		Not very helpful		Neutral
	Somewhat helpful		Helpful

We have listed a number of reactions which can follow an officer involved shooting. Please evaluate the extent and length of reactions you have experienced according to the following dimensions: (Extent of Reaction)
-1- -2- -3-	-4- -5- -6-	-7- -8- -9- -10-
Mildly	Moderately	Severely
Affected My Life and Coping Ability	Affected My Life and Coping Ability	Affected My Life and Coping Ability

Please rate how long you experienced the reaction according to the following scale: (How Long)
_1_	_2_	_3_	_4_	_5_
1 Month or Less	1-3 Months	3-6 Months	6-12 Months	Over 1 Year

Reaction	Extent of Reaction	How Long
Sense of loss of control over things
Sense of vulnerability
Nightmares
Intrusive images\thoughts (visual images, sounds, feelings, smells connected with event: and/or thoughts about event intrude in your mind)
Flashbacks (felt as if you were reliving the event)
Startled response (exaggerated response to sudden noise or movement)
Felt as if you were going "CRAZY"
Guilt
Self-second guessing
Heightened sense of danger
Poor concentration
Poor memory
Mark of Cain Complex (feel others are looking at you and negatively judging you)
Emotional numbing (less emotional)
Irritability
Avoidance of thoughts\feelings or activities associated with incident
Withdrawal from others
Loneliness/Isolation
Anger/Rage
Sleep disturbances
Sexual disturbance
Alienation
Distrust toward department
Distrust towards peers
Disciplinary problems
Decline in work performance
Increased absenteeism
Depression/Sadness
Low self-esteem
Family problems
Physical stress reactions (e.g., head or stomach aches, muscle tension, digestive problems, diarrhea, constipation, etc.)
Increase use of alcohol or drugs
Feelings of anxiety/Nervous Tension
Fear about future situations
Tendency to over-react (on job)
Tendency to under-react (on job)
Crying spells
Feeling of emptiness
Self-doubt
Confusion
Experiencing self as "unreal"
Disorientation
Oversuspiciousness
Suicidal thoughts
Hearing voices
Lack of energy
Overall rating of the reaction

How do you feel about the incident now? (Please check the appropriate box)
	I have accepted and resolved it. I am functioning as usual if not better.
	I have mostly accepted it. It bothers me a little but I am mostly able to enjoy life.
	Some aspects bother me and cause a little difficulty in my life.
	It bothers me moderately and causes some difficulty in my life.
	It bothers me tremendously and is causing much difficulty in my life.
How did you cope with the incident? (Please check your main strategy)
	Increased my drinking
	Avoided thinking about it\tried to put it out of my mind.
	Hobbies\recreation\relaxation\exercise

I talked with: (Please check the appropriate box)

	Family members		Peers\law enforcement friends		Non-police friends
	Clergy		Mental Health Professional		Physician

When did you first thoroughly talk about your incident?