Reporting

This Form is meant for the express use of Category I Members to report TEMS support for teams within Mississippi. Please list all pertinent information and if a field should be added for additional data collection please put that information along with any other comments in the feedback area at the base of the form.

THIS IS THE SHORT FORM...do not use if injuries occured

Short form criteria: Any training mission that involves live fire maneuvering, work at heights greater than 15 feet (rappelling, climbing, helicopter or ropes courses), explosive entry, or any other Ôhigh riskÕ environment. Any operational mission that involves no casualties.

* indicates information that must be completed

Agency/Team:	<Select> ATF Bollvar Co SO SWAT DEA FBI SWAT Forest PD SWAT HIDTA Hinds Co SO SWAT Jackson Municipal Airport Authority Jackson PD SWAT Madison Co SO SWAT Madison PD SWAT MBN MHP SWAT Pearl PD SWAT Rankin co SO SWAT Ridgeland PD SWAT US Marshal SRT *
First Name, Initial:	*
Last Name:	*
Rank/Title:
Location (city):	*
Type of Operation:	<Select> High Risk Warrant Service Barricade Hostage Resuce Dignitary Protection Crowd Control/Civil Disturbance Training *
Time deployed on mission:	*
Medical Preplan in place:	YES
Notes and/or narrative...	*

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