CIVIL ARREST REPORTING FORM – RULE OF COURT 10.440
Courthouse location: _________________________________
Date of Incident: ____ / ____ / ______
Time of Incident: __________ (AM / PM)
Exact location (Building / Floor / Area / Parking Lot):
Was the individual taken into custody?
[ ] Yes [ ] No [ ] Unknown
Agency conducting the Civil Arrest:
Were officers in uniform or plain clothes?
[ ] Uniform [ ] Plain Clothes [ ] Unknown
Did officers present government‑issued law enforcement identification?
[ ] Yes [ ] No [ ] Unknown
Did officers present a warrant?
[ ] Yes [ ] No [ ] Unknown
If a warrant was presented, indicate the type:
Additional information (if known or observed):
Reporting employee: _________________________________
Employee number: ________________
Supervisor reviewing report: _________________________
Date submitted: ____ / ____ / ______