Complete all information requested and submit white copy with a LAB-201, return yellow copy to kit, and retain pink copy.
Collecting Officer	Phone
Agency	Fax
Agency Case Number

Offense	Homicide Suicide Assault Drive-by Other

Individual (S = Suspect, V = Victim) Information

S / V	Name (Last, First, Middle, Suffix)	DOB
Subject is: Right-handed Left-handed Unknown
Was subject shot? YES NO
Any debris and/or suspected blood on subject’s hands? YES NO
Has subject washed their hands since shooting? YES NO Unknown
Was the subject in possession of a firearm when detained? YES NO
Did the subject admit to discharging a firearm? YES NO
Subject’s Occupation (if known):
Subject’s Hobbies (if known):
Brief description of subject’s activity between the time of the shooting and the time of the GSR collection:

Shooting Incident Information

Date and time shooting occurred:	Date Time AM PM
Date and time of evidence collection:	Date Time AM PM
Shooting location (e.g., kitchen, parking lot, indoors, outdoors):
Type of firearm used:	*Note: If ammunition manufacturer is unknown, draw head stamp here: Base of Cartridge
Firearm caliber:
Ammunition manufacturer*:
Ammunition caliber:
Number of shots fired:
Collecting Officer: AM PM Signature Date Time

White Copy – Submit with LAB-201	Yellow Copy – Place Inside GSR Kit	Pink Copy – Retain