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TACTICAL RESPONSE REPORT/Chicago Police Department 1. DATE OF INCIDENT TIME 2. ADDRESS OF OCCURRENCE 3. LOCATION CODE 4. BEAT/OCCUR 5. VIDEO RECORDED INCIDENT 05-NOV-2016 03:16:00 3120 S HALSTED ST CHICAGO, IL 60608 280 0913 01 BWC 02 IN-CAR CAMERA 03 OTHER REPT VIDEO D 6. POSITION 7. LAST NAME 8. FIRST NAME 9. STAR NO. 10. SEX 11. RACE CODE12. AGE 13. HT. 14. WT. RE EV 9161 CORONA RODRIGO J 7852 01 M 02 F S 505 155 BL MO 15. DATE OF APPT. 16. EMPLOYEE NO. 17. UNIT & BEAT OF ASSIGNMENT 18. DUTY STATUS 19. MEMBER INJURED? 20. MEMBER IN UNIFORM? MENV 01-MAY-2006 009 0911R 01 On 02 Off 01 Yes 02 No 01 Yes 02 No I 21. LAST NAME 22. FIRST NAME 23. M.I. 24. SEX 25. RACE 26. D.O.B. 27. HT. 28. WT. JARDINAS ANDY 01 M 02 F WWH 20-OCT-1993 502 115 DNA 29. ADDRESS 2617 W 36TH ST CHICAGO, IL 60632 30. TELEPHONE NO. 31. WAS SUBJECT ARMED? OTHER (SPECIFY) 32. SUBJECT INJURED BY 33. SUBJECT ALLEGED INJURY BY N MEMBER? MEMBER? O 01 Yes 02 No 01 Yes 02 No 01 Yes 02 No ECTRMATI 3IINN4JJ. UU IRRF EYSDU,B DJEESCCTRIBE 0013 FNaotna-lFatal - Minor Injury 0024 NNoonn--FAaptpaal r-e Mnta/Njoor nInejury 3M5. EWRHECREY W HASO MSEDPICITALA TLRE AATNMEDN TM OBETDAINICEDA?L CENTER UBJFO 36. BY WHOM? 37. CONDITION 01 Apparently Normal 02 Under Influence 03 Hospitalized SN ATTENDING I 04 Not Hospitalized 05 Refused Medical Aid 38. CHARGES PLACED DNA 39. CB NO. IR NO. DNA 720 ILCS 5.0/12-1-A, 720 ILCS 5.0/21-1.01-A-1, 720 ILCS 5.0/21-1-A-1 19393878 40. PASSIVE RESISTER ACTIVE RESISTER ASSAILANT:ASSAULT ASSAILANT:BATTERY ASSAILANT:DEADLY FORCE USES FORCE LIKELY TO DNA CT'SNS DVEIDR NBOALT DFIORLELCOTWION FLED IOMFM BINAETNTETR TYHREAT ATTACK WITH WEAPON CGARUESAET DBOEADTILHY O HRA RM RCE BJECTIO S(DTEIFAFDE WNEEDIG HT) PULLED AWAY OTHER WAS CLOSING DISTANCE AWTETAAPCOKN WITHOUT OWTEHAEPRO N O UA F S OTHER OTHER OTHER F PERCEIVED AS PERCEIVED AS Oy) E pl MEMBER PRESENCE OPEN HAND STRIKE Sp REASON FOR UCheck all that a MEMBER'SRESPONSE VEWAESRRRCIMSBOBTARALLTOR CHC OOKML DM SA N DS THOCTAAAAC0KSNN 1CEEDINH RCDEE UO(MPFWrIFoCN0IbAN2 e/LG ED WMisEcEAhRaPG0rOgE3eNN)CY ECSLTLBOROISKWEED /SP HTUARNNICKDHE KKNICEKES STRIKE FIREARM ( TASER (Contact Stun) PRESSURE SENSITIVE AREAS IMPACT WEAPON IMPACT MUNITION 01 02 03 (Describe in Box 40) (Describe in Box 40) OTHER CONTROL INSTRUMENT TASER (ARC Cycle) OTHER PUSHED SUBJECT BACK 01 02 03 OC/CHEMICAL WEAPON W/AUTHORIZATION TASER (Spark Displayed) LRAD WITH AUTHORIZATION 01 02 03 OTHER OTHER 41. * OC/CHEMICAL WEAPON AUTHORIZED BY (NAME) RANK STAR NO. UNIT NO. 42. DID THE INVOLVED MEMBER DISCHARGE A WEAPON ONLY TO DESTROY OR DETER AN ANIMAL? 01 Yes 02 No DNA 43. WAS THIS AN ACCIDENTAL DISCHARGE IN THE 44. DID THIS WEAON CONTRIBUTE TO A SUBJECT INJURY 45. DID THE DISCHARGE RESULT IN A SELF -INFLICTED INJURY? CONTEXT OF A NON-CRIMINAL INCIDENT? T 01 Yes 02 No 01 Yes 02 No 01 No 02 Yes - Subject 03 Yes - Member N DE 46. WEAPON TYPE 04 SEMI-AUTO PISTOL 47. INCIDENT OCCURRED 48. LIGHTING CONDITIONS 01 Daylight 49. WEATHER CONDITIONS CI 01 REVOLVER 05 CHEMICAL WEAPON Indoors Outdoors 02 Night 03 Dawn 04 Dusk OTHER N 05 Poor Artificial 06 Good Artificial E I 02 RIFLE 06 TASER (Probe Discharge) G 50. MAKE/MANUFACTURER 51. MODEL 52. BARREL LENGTH 53. CALIBER/GAUGE R 03 SHOTGUN 07 OTHER A H C 54. TASER DART ID NO. 55. WEAPON SERIAL No. (Include Letters) 56. CHICAGO GUN REG. NO. 57. IL FIREARM OWNER ID. NO. 58. HANDGUN CERTIFICATE NO. S DI PON 59. SPECIAL WEAPON CERTIFICATE NO. 60. PROPERTY INVENTORY NO. 61. TYPE OF AMMUNITION USED 6T2H.INSO M. EOMF BWEERA. PONS DISC0HARGED BY6M3E. MTOBETRAL F NIROE.D OF SHOTS 163 75. EVE A 1 N WE 64. WHO FIRED FIRST SHOT 03 OTHER (SPECIFY) 6D5U. RWINAGS IFNIRCEIDAERNMT RELOADED 6S6H.O NTO S OHFE LCLASRTRIDGES/ 67. HOW WAS MEMBER'S HANDGUN WORN 03 OTHER (Specify) 00 T NO 01 MEMBER 02 OFFENDER 01 YES 02 NO RELOADED 01 RT. SIDE (WAIST) 02 LT. SIDE (WAIST) 1 . 68. HOW WAS MEMBER'S HANDGUN DRAWN 03 OTHER (Specify) 69. SPECIFY METHOD/EQUIPMENT USED TO RELOAD 70. DID MEMBER USE SIGHTS 13 01 STRONG SIDE DRAW 02 CROSS DRAW 01 YES 02 NO 1 71. DESCRIBE PROTECTIVE COVER USED (LIGHT POLES, DOORWAYS, CAR, FURNITURE, ETC) 72. DISTANCE BETWEEN INVOLVED MEMBER & OFFENDER WHEN FIRST SHOT WAS FIRED H 73. PE0R1S SOUNB/OJEBCJETCT STRU03C KA NAISM RALESULT OF0 T5H SEU DBIJSECCHTA &R OGTEH OEFR M CEAMTBEEGRO'SR YWEAPON07 NONE 74. PO00S11I TS0I TO -A N0N 5OD FFINT M.GEMBER D00I22S 0LC5YH I-AN 1RG0G DFINTO.GW WNEAPON 0033 1S0IT -T 1IN5 GFT. 0044 OKNVEEREL 1IN5 GFT. Z5030 76. R.D. NO. 7 02 OTHER PERSON 04 OBJECT 06 UNKNOWN 08 ANY OTHER COMBINATION 05 OTHER (SPECIFY) 1 CPD-11.377 (REV. 3/16) Page 1 of 3 77. NOTIFICATIONS (ALL INCIDENTS) IMMEDIATE SUPERVISOR DSS OF DISTRICT OF OCCURRENCE 16 75. E ON NOTIFICATIONS (TASER, OC SPRAY, OTHER CHEMICAL WEAPONS INCIDENT): OEMC CPIC 31 VENT ASEMATI NMOeTmIFbIeCrAsT wIOilNl eSn (sUuSrEe OthFa Dt EalAl DreLqYu FirOeRd CnEo,t iFfiIcRaEtAioRnMs ,a IMndP AaCll Tw MitnUeNsIsTeIOsN toS , tLhRisA uDs, eC AoNf fIoNrEc eIN aCrIeD EdNocTu):mentedO iEnM thCe appropiate case report. 001 NO. CR 1 O 3 F 78. ADDITIONAL INFORMATION 1 N I S C79O. RREPOONRTAIN,G RMEOMDBERR I(GPriOnt N Jame) 7ST8A5R2/EMPLOYEE NO. SIGNATURE HZ 76. R URE 05-NOV-2016 05:09:22 50 .D. NO T Reviewing supervisor will ensure the legibility and completeness of this report and attest by entering the required information below. 3 . A 0 GN 80. REVIEWING SUPERVISOR (Print Name) STAR NO. SIGNATURE DATE REVIEWED TIME 7 SI LIAKOPOULOS, CHRISTOPH 2681 05-NOV-2016 05:13:27 1 CPD-11.377 (REV. 3/16) Page 2 of 3 LIEUTENANT OR ABOVE/INCIDENT COMMANDER REVIEW FOR REPORTABLE USE OF FORCE INCIDENTS, THE FOLLOWING RANKED SUPERVISOR WILL BE RESPONSIBLE FOR REVIEW AND APPROVAL OF ALL TRRS FROM THE SAME INCIDENT: 1. THE EXEMPT- LEVEL INCIDENT COMMANDER WILL REVIEW AND APPROVE THE FOLLOWING TYPES OF INCIDENTS: (A) THE DISCHARGE OF IMPACT MUNITIONS OR A FIREARM BY A DEPARTMENT MEMBER, EXCLUDING UNINTENTIONAL DISCHARGES WITH NO INJURY AND DISCHARGES TO DESTROY AN ANIMAL. (B) A MEMBER'S USE OF FORCE, BY WHATEVER MEANS, THAT RESULTS IN THE DEATH OR INJURIES LIKELY TO CAUSE DEATH OF ANY INDIVIDUAL. (C) ANY LESSER USE OF FORCE BY A DEPARTMENT MEMBER WHEN THAT USE OF FORCE STEMS FROM THE SAME INCIDENT IN WHICH ANOTHER MEMBER USED FORCE AS STATED ABOVE. 2. THE ASSIGNED DISTRICT OF OCCURRENCE MEMBER THE RANK OF CAPTAIN OR ABOVE WILL REVIEW AND APPROVE TRRS FOR THE FOLLOWING INCIDENTS: (A) THE DESTRUCTION OF AN ANIMAL WITH NO HUMAN INJURY. (B) AN ACCIDENTAL WEAPONS DISCHARGE WITH NO INJURY. (C) ANY INCIDENT NORMALLY INVESTIGATED BY A LIEUTENANT WHERE A LIEUTENANT IN THE DISTRICT OF OCCURRENCE IS NOT AVAILABLE. (3) THE ASSIGNED DISTRICT OF OCCURRENCE MEMBER THE RANK OF LIEUTENANT WILL INVESTIGATE ALL OTHER INCIDENTS. 81. SUBJECT'S STATEMENT REGARDING THE USE OF FORCE DNA REFUSED INTERVIEW NOT CONDUCTED (Specify Reason) Subject hospitalized 82. LIEUTENANT OR ABOVE/INCIDENT COMMANDER: COMMENTS Based upon the available information, the incident requires further investigation. 83. LIEUTENANT OR ABOVE/INCIDENT COMMANDER USE ONLY 84. LIEUTENANT OR ABOVE/INCIDENT COMMANDER DETERMINATION I HAVE REVIEWED THIS TRR AND COMPLIED WITH THE INDEPENDENT POLICE REVIEW AUTHORITY (IPRA) NOTIFIED. DUTIES OUTLINED IN G03-02-05. LOG NO. 1082884 OBTAINED 85. LIEUTENANT OR ABOVE/INCIDENT COMMANDER (Print Name) 86. BEAZLEY, THOMAS P TRR __________________________ OF _________________________TRR(S) 87. DISTRIBUTION OF TRR: IF A PAPER TRR WAS COMPLETED DUE TO AN UNAVAILABLILITY OF THE AUTOMATED TACTICAL RESPONSE REPORT APPLICATION: 1. THE ORIGINAL TRR WILL BE FORWARDED TO DIRECTOR, RECORDS DIVISION - TO BE INCLUDED WITH THE CORRESPONDING CASE FILE. 2. A COPY OF THE PAPER TRR WILL BE FORWARDED TO: A. INDEPENDENT POLICE REVIEW AUTHORITY, AND B. COMMANDER, INFORMATION SERVICES DIVISION, TO ENSURE DATA ENTRY INTO THE AUTOMATED TACTICAL RESPONSE REPORT APPLICATION. SIGNATURE DATE COMPLETED TIME 05-NOV-2016 12:25:46 CPD-11.377 (REV. 3/16) Page 3 of 3