NJ-UCR-369A (Rev. 09/18)
STATE OF NEW JERSEY
DEPARTMENT OF LAW & PUBLIC SAFETY
Law Enforcement Officers Killed or Assaulted
Monthly Supplement
(Also Include on Return A)
N.J.
Municipal Code Number
NCIC Code Number
0 0
OFFICERS KILLED — Number of your law enforcement officers killed in the line of duty this month:
By Felonious Act: By Accident or Negligence:
POLICE OFFICERS ASSAULTED — (Do not include officers killed):
TYPE OF WEAPON USED TYPE OF ASSIGNMENT
CIRCUMSTANCE
TOTAL
ASSAULT
FIREARM
KNIFE/
OTHER
CUTTING
OBJECT
OTHER
WEAPON
PHYSICAL
FORCE
TWO
OFFICER
VEHICLE
ONE OFFICER
VEHICLE
DETECTIVE or
SPECIAL
ASSIGNMENT
OTHER
POLICE
ASSAULTS
CLEARED
ALONE ASSISTED ALONE ASSISTED ALONE ASSISTED
A B C D E F G H I J K L M
1. Responding to "Disturbance" calls (family
quarrels, man with gun, etc.)
2. Burglaries in progress or pursuing burglary
suspects
3. Robberies in progress or pursuing robbery
suspects
4. Attempting other arrests
5. Civil disorder (riot, mass disobedience, etc.)
6. Handling, transporting, custody of prisoners
7. Investigating suspicious persons or
circumstances
8. Ambush — no warning
9. Handling persons with mental illness
10. Traffic pursuits and stops
11. All other
12. Total (1 - 11)
13. With personal injury
14. Without personal injury
AM
15. Time of assaults PM
12:01 2:00 4:00 6:00 8:00 10:00 12:00
All information should be entered into the UCR System by the 7th day after the close of the reporting
period.
DO NOT: Email, Fax, or Mail a paper copy of this form to the New Jersey State Police.
Report for the Month of:
Prepared by:
Date:
Department:
Head of Department
DO NOT USE THIS SPACE
INITIALS
RECORDED
REVIEWED
PUNCHED
VERIFIED
ADJUSTED
POP GROUP
CHARACTER
