LASD Law Enforcement Death Report (LEDR)

A LEDR is to be completed for all death classifications for sworn employees.
Purpose: To capture risk-factor data in suspected or known cases of suicide as well as general mortality information, not to determine possible negligence or accountability.  Note: Leave unknown items blank. 

I.  Administrator Information

Date you forwarded the LEDR (MM/DD/YYYY): __ __ / __ __ / __ __ __ __ 
Date of incident (MM/DD/YYYY): __ __ / __ __ / __ __ __ __ 
Agency Name: _________________________________________________
Chief’s Name: _________________________________________________
Information on individual completing this form
	Name: ________________________________________________________ 
Degree/Credential: ______________________________________________
	Job Title:______________________________________________________
	Number of years with this agency: _________________________________
	Phone: _______________________________________________________
	Best time to contact: ____________________________________________ 
As you complete this report, please indicate which types of sources you accessed (check all that apply):
‘	Personnel Record
‘	Medical Record
‘	Autopsy Report
‘	Ballistics Report
‘	Financial (debt) Record
‘	Suicide Note
‘	Investigative Report
‘	Sworn Statement
‘	Interview
‘	Other ______________	How many people were consulted for this report (enter zero for none):
____Supervisor(s)
____Co-worker(s)
____Chaplain
____Drug & Alcohol Counselor
____Mental Health Professional
____Medical Care Professional
____Peer Support
____Family Members  

II.	Decedent Information

Decedent’s Name:____________________________	Employee #  _____________________
Sex:	‘	Male			‘	Female
Birth Date (MM/DD/YYYY): __ __/ __ __ / __ __ __ __ 
Date of Hire (MM/DD/YYYY): __ __/ __ __ / __ __ __ __ 
Date of anticipated retirement (MM/DD/YYYY): __ __ / __ __  / __ __ __ __ 
Unit of Assignment:______________________
Rank:
‘	Line Staff (e.g. Officer, Deputy)
‘	Detective
‘	1st Level Supervisor
‘	Middle Manager
‘	Executive	Highest Education Level:

‘	HS Graduate		‘	Assoc. Degree
‘	HS GED			‘	Bachelor-level degree
‘	HS diploma		‘	Masters-level degree
‘	Some college		‘	Post-Masters-level	

Marital Status:
‘	Never married		‘	Divorced
‘	Living together		‘	Widowed
‘	Married			‘	Remarried
‘	Legally separated
If separated/divorced/widowed, date:  __ __ / __ __ / __ __ __ __ 
Number of times married (including current) ____
Child custody issues:  ‘      Yes 	‘       No
Was the decedent known to practice an alternative lifestyle relationship?
     Specify: ________________________________________________	Race/Ethnicity:
‘	Caucasian
‘	African-American
‘	Hispanic
‘	American Indian
‘	Asian/Malaysian/Pacific Islander
‘	Eskimo/Aleutian Islander
‘	Unknown by decedent (e.g. adopted)
‘	Other _________________	
Residence:
‘	Live-in Academy
‘	Apartment
‘	House
‘	Other ____________________
Was residing with:
‘	Spouse/Significant Other
‘	Partner
‘	Roommate(s)
‘	Parent(s)
‘	Child(ren)
‘	Other type(s):_______________
‘	No one; resided alone	Religious Preference:

‘	Catholic
‘	Jewish
‘	Mormon
‘	Baptist
‘	Other Protestant
‘	None/Atheist/Agnostic
‘	Other ______________	
Military History

‘	No military service
‘	Yes, #__ __ years of service
	Branch 
	‘	USA
	‘	USN
	‘	USMC
	‘	USAF
	‘	USCG
	‘	Currently Reserve Forces
	‘	Other 	_____________________
	‘	Specialty training/assignment
 	(MOS): _______________
‘	Combat experience
	If so,	when _____________________
    	   	where  ____________________
Military Discharge
‘	Honorable
‘	General
‘	Medical
‘	Less than honorable
‘	Dishonorable
	Date of discharge
 	__ __ / __ __ / __ __ __ __ MM/DD/YYYY	
What category best describes decedent’s work function? 
‘	Patrol
‘	Court
‘	Academy
‘	Custody
‘	Detective/Investigations
‘	Administrative
‘	Other___________________	Was decedent involved in an undercover assignment?
‘	Short undercover  (e.g. buy/bust)
‘	Deep undercover (i.e. living alternative identity)

What is the agency’s off duty firearm policy?
‘	May not carry an off duty weapon
‘	May carry (but not required)
‘	Must carry	

III.	Circumstances of Death

Date of Death (MM/DD/YYYY):__ __/ __ __ / __ __ __ __	Time of Death (24-hour clock; local time):	 __ __: __ __ 
Date of Illness or Injury (if incident did not result in immediate death)  (MM/DD/YYYY): __ __/ __ __ / __ __ __ __ 
Date Body Found (MM/DD/YYYY): __ __/ __ __ / __ __ __ __ 
Case Status:

•		Confirmed suicide
•	Determination pending
•		Confirmed not a suicide
Place of Death:	‘	Indoors		‘	Outdoors
Please specify location:
‘	Own Residence
‘	Other’s Residence  (relationship to decedent: ________________)
‘	Assigned work building
‘	In the field (i.e. on patrol)
‘	Medical
‘	Other building
‘	Public area, isolated
‘	Public common area
‘	Other  ________________________
Is location of significance?  If so, please specify _____________________________________________________	Duty Status at Time of Death:
‘	On duty
‘	Off duty
‘	Vacation-time
‘	Off duty due to injury or illness
‘	Off duty pending investigation
‘	Suspended
‘	Relieved of duty	
Cause of Death - if known				‘	Cirrhosis
‘	Cancer - specify ______________________	‘	Diseases of the respiratory system (pneumonia, bronchitis)
‘	Diabetes					‘	Ulcer   
‘	Blood and blood forming organs		‘	Diseases of intestine and peritoneum
‘	Hemorrhage/embolism/thrombosis 		‘	Motor vehicle accident
‘	Multiple sclerosis				‘	Other accident - specify _____________________________
‘	Diseases of the heart			‘	Suicide 
‘	Hypertensive diseases			‘	Homicide
‘	Pulmonary embolism, infarction		‘	Other - specify ____________________________________	
If self-inflicted (whether accidental or intentional) - method:
‘	Firearm/Gunshot			‘	Ingestion
‘	Cutting/Piercing			‘	Jumping from height
‘	Hanging				‘	Involved in single vehicle traffic collision
‘	Carbon Monoxide			‘	Other (describe)_______________________	
If gunshot, body location of gunshot wound:

‘	Head
‘	Chest
‘	Abdomen
‘	Other ___________________	Type of firearm used:
‘	Handgun
‘	Revolver/Semi automatic 
‘	Shotgun
‘	Rifle
‘	Other ___________________	
Weapon Source:

‘	Duty weapon or issued weapon
‘	Owned by decedent
‘	Owned by other person ___________
‘	Other ____________________
	Obtained how soon prior to death:
‘	Within 1 week
‘	Within 2 weeks
‘	Within 1 month
‘	Within 3 months
‘	Within 1 year
‘	More than 1 year.	
If jumped, from what structure?

‘	Building
‘	Bridge
‘	Natural site (e.g. cliff, ravine)
‘	Other___________________
	If method was cutting/piercing, body location:
‘	Wrist(s)
‘	Forearm(s)
‘	Throat
‘	Chest
‘	Abdomen
‘	Other ______________________	
What degree of difficulty, elaboration was present?
‘	Low (simple, straight forward means of death)
‘	Medium (some ritual, elaboration involved - e.g. formal uniform)
‘	High (great deal of ritual, preparation or elaboration involved in death)	Any evidence of rehearsal involved in the death (i.e. person had practiced the act or features of it before the event)?
‘	Yes______________________________________________
‘	 No

Any evidence the incident involved death-risk gambling (e.g. Russian roulette, walking railroad tracks)?
‘	Yes _____________________________________________  
‘	No	
Was alcohol used during the incident?
‘	No
‘	Unlikely
‘	Likely
‘	Yes
If yes, blood alcohol level (BAC) __. __ __ g/dl	Evidence of other substance involvement:
1 No	  2 Unlikely	  3 Likely		4 Yes
_____ Psychotropic/Pain/sleep prescription medication
_____ Other prescription medication(s)
_____ Non-prescription medication(s)
_____ Illegal/Illicit substance/chemical(s)
_____ Other ________________________	
Was there any accompanying act of violence (e.g. threats, hostage taking, assault, domestic violence, stalking, homicide)? 
‘	No 
‘	Yes ____________________________	If yes, was a homicide involved?
‘	No 
‘	Yes, relationship with murder victim: _____________________________
	
Was anyone within range to vocally or physically intervene?
‘	No
‘	Unlikely
‘	Possibly
‘	Yes
‘	Undetermined	By whom was the body first encountered/discovered?
‘	Family member (Specify ___________)
‘	Coworker
‘	Friend
‘	Medical professional
‘	Police officer
‘	Other ________	
Did the decedent recently communicate suicidal ideation/intent?  If so, to whom?  (Check all that apply.)
‘	Unknown/no one				‘	Medical professional 
‘	Significant other				‘	Chaplain
‘	Family member (e.g. parent, sibling, etc.)	‘	Other helping-services person
‘	Friend/Coworker				‘	Other___________________
‘	Supervisor	

IV.	Employment History

The level of the decedent’s last overall performance rating:
‘	Above average
‘	Average
‘	Below average
‘	Performance rating date
 (MM/DD/YYYY) __ __ / __ __ / __ __ __ __ 	The level of the decedent’s next to last overall performance rating:
‘	Above average
‘	Average
‘	Below average
‘	Performance rating date
 (MM/DD/YYYY) __ __ / __ __ / __ __ __ __ 	
Disciplinary History
‘	Never disciplined
‘	Pending discipline
‘	Minor discipline (verbal warning, entry in log book)
‘	Once
‘	2-5 times
‘	5 or more times
‘	Major discipline/Suspension (written warning, remedial training, suspension)
	‘	Once
	‘	2-5 times
	‘	5 or more times
	‘	Fired/Rehired	Received any significant individual awards for exceptional work performance?
‘	No 
‘	Yes, one
‘	Yes, two to five
‘	Yes, more than five

Received any significant awards for courageous service/bravery? (E.g. Medal of Valor)
‘	No 
‘	Yes, one
‘	Yes, two to five
‘	Yes, more than five	
Had decedent ever been convicted of domestic violence?
Spouse/Relp. Partner  Abuse	‘ No		‘ Yes
Date (MM/DD/YYYY) _________________
Child Abuse      			‘ No		‘ Yes
Date (MM/DD/YYYY) _________________		
Within the 12 month prior, any evidence of:
‘	Job dissatisfaction
‘	Involved in grievance or filing against the employer?
‘	Worked other than a regular daytime work shift?
‘	Documented problems with authority?
‘	Evidence of legal problems?
‘	Under investigation for criminal behavior? 
‘	Under apprehension for criminal behavior?	
‘	Under administrative investigation for behavior?
‘	Subject of civil legal difficulty?
‘	Serious financial problems?
‘	Recent interest in or arrangement for his/her personal affairs?
‘	Recent relationship problem?
‘	Recent death of a loved one?
‘	History of violent/aggressive behavior?
‘	Problems regulating emotions?
‘	Problems handling/managing job stress?	
Assess the decedent’s level of integration or interaction in the unit.
‘	None/kept to self
‘	Marginal/minimal
‘	Average/got along OK
‘	Above average/well regarded
‘	Strong/highly regarded	Assess the decedent’s support system:
‘	1 	No friends/Little or no Support
‘	2
‘	3	Some Friends/Average Support
‘	4
‘	5 	Many Friends/Good Support	
Level of participation in non-work connected off-duty activities (e.g. hobbies, education, and religious groups)?
‘	None			‘	Regular
‘	Infrequent		‘	Very Frequent
‘	Occasional	Over the year prior to death, the decedent’s job performance and work behavior was described by supervisors or coworkers as:
‘	Poorer than usual
‘	Usual
‘	Better than usual	
Did the decedent make any comment(s) about future plans or life goals in the weeks prior to death?
‘	No
‘	Yes ____________________________	Supervisors or coworkers characterized the decedent’s behavior in the two weeks prior to death as:
‘	Usual
‘	Unusual (specify): _________________ ________________________________	

V.	Use of Deadly Force

Number of officer involved shooting incidents _____?  For each incident, please provide the following information (if more than four, use additional page):
Most recent incident	
(MM/DD/YYYY) __ __ / __ __  / __ __ __ __ 
‘	within 1 year of death
‘	between 1 and 2 years before death
‘	2 years or more before death
Was decedent injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury
Was fellow officer/colleague injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury	‘	Deceased
Was suspect injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury	‘	Deceased	Second most recent incident	
(MM/DD/YYYY) __ __ / __ __  / __ __ __ __ 
‘	within 1 year of death
‘	between 1 and 2 years before death
‘	2 years or more before death
Was decedent injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury
Was fellow officer/colleague injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury	‘	Deceased
Was suspect injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury	‘	Deceased	
Has the authority to be armed ever been denied or withdrawn?	‘	No		‘	Yes
Date (MM/DD/YYYY)___________________	Any complaints for using excessive force (brutality charges)?
‘	No		‘	Yes
Date (MM/DD/YYYY)___________________	
Third most recent incident	
(MM/DD/YYYY) __ __ / __ __  / __ __ __ __ 
‘	within 1 year of death
‘	between 1 and 2 years before death
‘	2 years or more before death
Was decedent injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury
Was fellow officer/colleague injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury	‘	Deceased
Was suspect injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury	‘	Deceased	Fourth most recent incident	
(MM/DD/YYYY) __ __ / __ __  / __ __ __ __ 
‘	within 1 year of death
‘	between 1 and 2 years before death
‘	2 years or more before death
Was decedent injured at the time?
‘	No injury	 	‘	Major injury
‘	Minor injury
Was fellow officer/colleague injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury	‘	Deceased
Was suspect injured at the time?
‘	No injury		‘	Major injury
‘	Minor injury	‘	Deceased	

VI.	Pre-Employment Screening

Was there a pre-employment psychological evaluation?
‘	No		‘	Yes	Any evidence of pre-hire psychological problems?
‘	No		‘	Yes
Specify ____________________________________________
___________________________________________________	

VII.	Medical History

Medical problems
‘	Injury requiring significant return to work time (e.g. one month)?
‘	Recent catastrophic diagnosis (e.g. cancer, HIV+)?	
Specify: ______ _________________
‘	Chronic illness/condition (e.g. back pain, migraine, diabetes)?
Specify: ________________________
‘	Career-ending injury?
‘	Other(s)_________________________

How many outpatient visits for medical problems in the 12 months prior to the death?
‘	Unknown		‘	3-7
‘	None		‘	8-12
‘	1-2		‘	13+	Any currently prescribed medications?
‘	Unknown		‘	No
‘	Yes specify _______________________________
________________________________________
________________________________________

Who supervised prescribed medications?
‘	Primary care physician’s assistant/nurse practitioner
‘	Primary care physician
‘	Psychologist with prescription rights
‘	Psychiatrist
‘	Other ___________________________________	

VIII.	Alcohol and Substance Use History

Ever any alcohol-related problems (e.g. binge drinking, DUI, alcohol abuse or dependence)?
‘	Yes, within 3 months prior.
‘	Yes, between 3-12 months prior.
‘	No (not within 12 months prior to death).

If yes, with DUI episode(s)?
‘	No		‘	Yes	Any change in alcohol use behavior within 2 weeks of death?
‘	Significant increase
‘	Slight increase
‘	No
‘	Slight decrease
‘	Significant decrease
‘	Other, specify: ________________________________	
Any change in non-alcohol substance behavior within 2 weeks of death?
‘	Significant increase
‘	Slight increase
‘	No
‘	Slight decrease
‘	Significant decrease
‘	Other, specify: ________________________________	Did the decedent receive treatment for alcohol or other substance abuse?
Alc	Substance
•	‘	No
•	‘	Within last 6 months
•	‘	Within last year
•	‘	Greater than 1 year ago	
If decedent received tx, what substances were involved  (check all that apply)?
‘	Marijuana	‘	Steroids	
‘	Hashish		‘	Ritalin
‘	Cocaine		‘	Amphetamine
‘	Inhalant(s) (glue, nitrous oxide)
‘	Hallucinogens ( LSD, Ecstasy, Peyote)
‘	Prescription medication - specify
________________________________
‘	Over-the-counter
‘	Other(s) ________________________________	Most recent substance abuse episode:
‘	Within 2 weeks prior to death
‘	Within year prior to death
‘	Between date of hire & 1 year before death
‘	Prior to date of hire
‘	No episode

IX.	Mental Health History

Was the decedent ever evaluated or treated for a psychiatric condition (including suicidal ideation or attempt)?
‘	Yes, within 3 months prior to death
‘	Yes, between 3-12 months prior
‘	Yes, over 12 moths prior
Last date of tx (MM/DD/YYYY):
 __ __ / __ __ / __ __ __ __ 	Treatment status (tx):
‘	In tx
‘	Withdrew/failed to complete treatment
‘	Was terminated from a treatment program by treatment provider
‘	In aftercare
‘	Tx/Aftercare completed
‘	No tx
‘	Other ___________________________________________	
Ever diagnosed with a Mental Health disorder?
‘	No		‘	Yes 
DSM-IV primary diagnosis (most recent):
______________________________________
______________________________________
Axis I: __ __ __. __ __ 
Axis II: __ __ __ . __ __ 
Axis III: _____________________________
Axis IV: _____________________________
Axis V: ______________________________	Number of times hospitalized?
‘	None
‘	One
‘	Two or more

 If hospitalized, most recent duration ___ week(s)

Last date of tx 
(MM/DD/YYYY): __ __ / __ __ / __ __ __ __ 
	
Disposition (check all that apply):
‘	Inpatient - involuntary
‘	Inpatient - voluntary
‘	Outpatient - off work
‘	Returned to full duty, with follow-up care
‘	Returned to full duty, with no follow-up care
‘	Other ________________	Evidence of non-compliance with recommended tx?
‘	No
‘	Yes: ____________________________________________________________________________________________________	
Any previous suicide gestures/attempts?
‘	None
‘	One
‘	Two
‘	Three
‘	Four or more	If yes, most recent prior method
Date (MM/DD/YYYY) __ __ / __ __ / __ __ __ __
‘	Firearm/Gunshot		‘	Ingestion
‘	Cutting/Piercing		 ‘	Jumping from height
‘	Hanging			 ‘	Carbon Monoxide
‘	Other ___________________________	
Did the decedent recently express/demonstrate any of the following (check all that apply)?
‘	A desire to die
‘	A desire to be free of all problems
‘	Lack of interest in usual activities
‘	Feelings of depression
‘	Feelings of hopelessness/uselessness
‘	Feelings of anxiety
‘	Feelings of powerlessness
‘	Feelings of failure
‘	Feelings of shame, guilt, or remorse
‘	Changes in usual sleep patterns
‘	Changes in eating patterns
‘	Weight gain or loss
‘	Change in usual mood
‘	Rejection by loved one
‘	Feeling of being burden to others
‘	Loneliness
‘	Isolation
‘	Impulsivity
‘	Self-deprecation
‘	Self-mutilation	Excluding the decedent, any family history of (check all that apply):
‘	Substance abuse
‘	Depression
‘	Suicide gestures/attempts
‘	Suicide

Any evidence decedent was a child abuse victim?
‘	No
‘	Yes

Was the decedent awaiting any of the following?
‘	Workman’s Compensation evaluation/findings
‘	Fitness for duty evaluation/findings
‘	Under investigation
‘	Other legal judgment/processing (past or current)?

If yes, for how long? __ __ week(s) prior to death	
Any evidence the decedent used the following services within 12 months prior to death?
1= No, not within 12 months prior to death
2= Yes, with 1 month prior to death
3= Yes, between 1-3 months prior to death
4= Yes, between 3-12 months prior to death
_____ Medical treatment facility	_____ Stress management
_____ Substance abuse services	_____ Chaplain service
_____ Mental Health Services	_____ Peer Support
_____ Financial counseling		_____ Anger management
_____ EAP (Employee Assistant Program)	If the decedent did not seek treatment, were there any  barriers attributed to decedent re seeking assistance?
‘	Stigma attached to seeking assistance
‘	Concerns regarding the potential for being releived of duty
‘	Lack of awareness of resources
‘	Involved in promotional process
‘	Involved in child custody dispute
‘	Other___________________________________
________________________________________	

X.	Department Environment

Within 1 year prior to the decedent’s death, how many suicides occurred at the department?	Enter number:  __ __
	
Within 1 year prior to the decedent’s death, how many suicide attempts/gestures occurred at the department?
Enter number including any by decedent: __ __

Within 1 year prior to the decedent’s death, how many suicides did decedent respond to while on duty?    Enter number:  __ __
Did decedent attend suicide awareness or stress management training?
‘	No
‘	Yes, within 3 months of death
‘	Yes, within 6 months
‘	Yes, within 1 year
‘	Yes, longer ago than 1 year before death	Any evidence decedent read a news report or viewed a TV or video program about suicide within 3 months prior (excluding suicide awareness training)?
‘	No
‘	Yes	

Final Summary Impression
Please include any additional observations or findings you feel relevant plus a brief evaluation of the incident in your own words:
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Department Interview Form

Directions: This form is to be used to record information from personnel familiar with the decedent (e.g. supervisor, CO-workers, peers).  Interviews should be conducted ONLY with individual’s who are directly affiliated with the decedent.  Use one form per respondent.

Respondent’s relation to decedent:
‘	Chaplain
‘	Supervisor
‘	CO-worker
‘	Room-mate
‘	Spouse/relationship partner
‘	Peer support person
‘	Family member (specify parent, sibling, child, etc.__________________)
‘	Other ______________________________________	Respondent’s frequency of contact with decedent:
‘	Daily
‘	Almost daily
‘	Weekly
‘	Almost weekly
‘	Monthly
‘	Several times
‘	Once 
‘	None	
Date(s) of interview:  (MM/DD/YYYY): __ __ / __ __ / __ __ __ __ 
Form filled out by: respondent/interviewer/other ___________________

Please provide a description of the deceased’s behavior or emotional state prior to the fatal event.
____________________________________________________________________________________
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In your view, what seemed to be the event(s)/problem(s) that led to the deceased’s death?
____________________________________________________________________________________
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What, if any, resources do you feel would have been helpful to have had available that might have assisted the suicidal individual?
____________________________________________________________________________________
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If the death appears to have been an unexplained impulsive act, please describe the circumstances surrounding the incident (e.g. accident, accidental infliction of harm to another, arrest or conviction of crime.
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