AB 953: TEMPLATE BASED ON THE FINAL REGULATIONS
Additional data values for the stop of a student in a K-12 public school are listed in red.
November 7, 2017 Page 1
1. Originating Agency Identifier (prepopulated field)
2. Date, Time, and Duration of Stop
Date: (e.g., 01/01/19)
Start Time (approx.): (e.g. 1530)
Duration of Stop (approx.): (e.g. 30 min.)
3. Location
Report one (listed in order of preference): block number and street name; closest intersection; highway and closest highway exit. If none of these are available, the officer may report a road marker, landmark, or other description, except cannot report street address if location is a residence.
City:_______________
Check here to indicate stop is of a student at K-12 public school: _________ o Name of -12 Public School ____________
4. Perceived Race or Ethnicity of Person Stopped (select all that apply) Asian
Black/African American
Hispanic/Latino(a)
Middle Eastern or South Asian
Native American
Pacific Islander
White
5. Perceived Gender of Person Stopped (may select one from options 1-4 AND option 5, if applicable, or just option 5)
1. Male
2. Female
3. Transgender man/boy
4. Transgender woman/girl
5. Gender nonconforming
6. Person Stopped Perceived to be LGBT (Yes/No) (“Yes” must be selected if “Transgender” was selected for “Perceived Gender”)
7. Perceived Age of Person Stopped (input the perceived, approximate age)
8. Person Stopped Has Limited or No English Fluency (check here if Yes _____)
9. Perceived or Known Disability of Person Stopped (select all that apply) o Deafness or difficulty hearing
o Speech impairment or limited use of language
o Blind or limited vision
o Mental health condition
o Intellectual or developmental disability, including dementia o Disability related to hyperactivity or impulsive behavior o Other disability
o None
AB 953: TEMPLATE BASED ON THE FINAL REGULATIONS
Additional data values for the stop of a student in a K-12 public school are in listed in red.
November 7, 2017 Page 2
10. Reason for Stop (select one - the primary reason for the stop only) o Traffic violation
Specific code (CJIS offense table; select drop down) and Type of violation (select one)
Moving violation
Equipment violation
Non-moving violation, including registration violation o Reasonable suspicion that person was engaged in criminal activity Specific Code (drop down; select primary if known) and Basis (select all applicable)
Officer witnessed commission of a crime
Matched suspect description
Witness or victim identification of suspect at the scene Carrying suspicious object
Actions indicative of casing a victim or location
Suspected of acting as a lookout
Actions indicative of a drug transaction
Actions indicative of engaging in a violent crime
Other reasonable suspicion of a crime
o Known to be on parole/probation/PRCS/mandatory supervision o Knowledge of outstanding arrest warrant/wanted person o Investigation to determine whether person was truant
o Consensual encounter resulting in search
o Possible conduct warranting discipline under Education Code sections 48900, 48900.2, 48900.3, 48900.4, and 48900.7 (select specific Educ. Code section & subdivision) o Determine whether student violated school policy
A brief explanation is required regarding the reason for the stop and must provide additional detail beyond the general data values selected (250-character maximum).
11. Stop Made in Response to a Call for Service (Yes/No) (Select “Yes” only if stop was made in response to call for service, radio call, or dispatch)
12A. Actions Taken by Officer(s) During Stop (select all that apply) o Person removed from vehicle by order
o Person removed from vehicle by physical contact
o Field sobriety test conducted
o Curbside detention
o Handcuffed or flex cuffed
o Patrol car detention
o Canine removed from vehicle or used to search
o Firearm pointed at person
o Firearm discharged or used
o Electronic control device used
o Impact projectile discharged or used (e.g. blunt impact projectile, rubber bullets or bean bags) o Canine bit or held person
o Baton or other impact weapon used
o Chemical spray used (e.g. pepper spray, mace, tear gas, or other chemical irritants) o Other physical or vehicle contact
o Person photographed
AB 953: TEMPLATE BASED ON THE FINAL REGULATIONS
Additional data values for the stop of a student in a K-12 public school are in listed in red.
November 7, 2017 Page 3
o Asked for consent to search person
Consent given
Consent not given
o Search of person was conducted
o Asked for consent to search property
Consent given
Consent not given
o Search of property was conducted
o Property was seized
o Vehicle impound
o Admission or written statement obtained from student
o None
12B. Basis for Search (if search of person/property/both was conducted; select all that apply) o Consent given
o Officer safety/safety of others
o Search warrant
o Condition of parole/probation/PRCS/mandatory supervision o Suspected weapons
o Visible contraband
o Odor of contraband
o Canine detection
o Evidence of crime
o Incident to arrest
o Exigent circumstances/emergency
o Vehicle inventory (for search of property only)
o Suspected violation of school policy
A brief explanation is required regarding the basis for the search and must provide additional detail beyond the general data values selected (250-character maximum). This field is not required if basis for search is “condition of parole/probation/PRCS/mandatory supervision.” 12C. Contraband or Evidence Discovered, if any (during search/in plain view; select all that apply) o None
o Firearm(s)
o Ammunition
o Weapon(s) other than a firearm
o Drugs/narcotics
o Alcohol
o Money
o Drug paraphernalia
o Suspected stolen property
o Cell phone(s) or electronic device(s)
o Other contraband or evidence
12D. Basis for Property Seizure (if property was seized; select all that apply) o Safekeeping as allowed by law/statute
o Contraband
o Evidence
o Impound of vehicle
AB 953: TEMPLATE BASED ON THE FINAL REGULATIONS
Additional data values for the stop of a student in a K-12 public school are in listed in red.
November 7, 2017 Page 4
o Abandoned property
o Suspected violation of school policy
Type of Property Seized (select all that apply)
o Firearm(s)
o Ammunition
o Weapon(s) other than a firearm
o Drugs/narcotics
o Alcohol
o Money
o Drug paraphernalia
o Suspected stolen property
o Cell phone(s) or electronic device(s)
o Vehicle
o Other contraband or evidence
13. Result of Stop (select all that apply)
o No action
o Warning (verbal or written): Code/ordinance cited (drop down) o Citation for infraction: Code/ordinance cited (drop down) o In-field cite and release: Code/ordinance cited (drop down) o Custodial arrest pursuant to outstanding warrant
o Custodial arrest without warrant: Code/ordinance cited (drop down) o Field Interview Card completed
o Noncriminal transport or caretaking transport (including transport by officer, transport by ambulance, or transport by another agency)
o Contacted parent/legal guardian or other person responsible for the minor o Psychiatric hold (Welfare & Inst. Code, §§ 5150, 5585.20.) o Referred to U.S. Department of Homeland Security (e.g., ICE, CBP) o Referral to school administrator
o Referral to school counselor or other support staff
14. Officer’s Identification (I.D.) Number (prepopulated field)
15. Officer’s Years of Experience (total number of years worked as a peace officer)
16. Type of Assignment of Officer (select one)
o Patrol, traffic enforcement, field operations
o Gang enforcement
o Compliance check (e.g. parole/PRCS/probation/mandatory supervision) o Special events (e.g. sports, concerts, protests)
o Roadblock or DUI sobriety checkpoint
o Narcotics/vice
o Task force
o K-12 public school, including school resource officer or school police officer o Investigative/detective
o Other (manually specify type of assignment)