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Revised Incident Record Form

This document is a template for recording incidents in the Philippine National Police blotter. It includes sections for documenting details of the reporting person, suspect, victim, and narrative of the incident. The reporting person is asked to provide identifying information and certify that the narrative is correct to the best of their knowledge. A police officer then signs to acknowledge receiving the report and records the incident in the official blotter. The reporting person is given a copy to check on the status of any investigation into the reported crime or incident.

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Rafael Juico
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6K views2 pages

Revised Incident Record Form

This document is a template for recording incidents in the Philippine National Police blotter. It includes sections for documenting details of the reporting person, suspect, victim, and narrative of the incident. The reporting person is asked to provide identifying information and certify that the narrative is correct to the best of their knowledge. A police officer then signs to acknowledge receiving the report and records the incident in the official blotter. The reporting person is given a copy to check on the status of any investigation into the reported crime or incident.

Uploaded by

Rafael Juico
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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P Ph hi il li ip pp pi in ne e N Na at ti io on na al l P Po ol li ic ce e

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IRF ENTRY NUMBER: TYPE OF INCIDENT:

COPY FOR:
INSTRUCTIONS: Refer to PNP SOP on Recording of Incidents in the Police Blotter in filling up this form. This Incident Record Form (IRF) may be reproduced, photocopied,
and/or downloaded from the DIDM website, www.didm.pnp.gov.ph.
DATE AND TIME REPORTED: DATE AND TIME OF INCIDENT: PLACE OF INCIDENT:
ITEM A - REPORTING PERSON
FAMILY NAME


FIRST NAME MIDDLE NAME

QUALIFIER NICKNAME
CITIZENSHIP


SEX/GENDER

CIVIL STATUS DATE OF BIRTH (MM/DD/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE

CURRENT ADDRESS (HOUSE NUMBER/STREET)


VILLAGE/SITIO

BARANGAY

TOWN/CITY

PROVINCE

OTHER ADDRESS (HOUSE NUMBER/STREET)


VILLAGE/SITIO

BARANGAY

TOWN/CITY

PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT


OCCUPATION ID CARD PRESENTED

EMAIL ADDRESS (If Any)

ITEM B SUSPECTS DATA
FAMILY NAME


FIRST NAME

MIDDLE NAME

QUALIFIER NICKNAME
CITIZENSHIP


SEX/GENDER

CIVIL STATUS DATE OF BIRTH (MM/DD/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE

CURRENT ADDRESS (HOUSE NUMBER/STREET)


VILLAGE/SITIO

BARANGAY

TOWN/CITY

PROVINCE

OTHER ADDRESS (HOUSE NUMBER/STREET)


VILLAGE/SITIO

BARANGAY

TOWN/CITY

PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT


OCCUPATION WORK ADDRESS RELATION TO
VICTIM
EMAIL ADDRESS (If Any)

IF AFP/PNP PERSONNEL: RANK


UNIT ASSIGNMENT

GROUP AFFILIATION WITH PREVIOUS CRIMINAL RECORD?
[ ] Yes [ ] No
(If Yes, Pls. Specify)

STATUS OF PREVIOUS CASE

HEIGHT WEIGHT BUILT COLOR OF EYES DESCRIPTION OF EYES COLOR OF HAIR DESCRIPTION OF HAIR UNDER THE INFLUENCE?
NO DRUGS LIQUOR
OTHERS
________________________
FOR CHILDREN IN CONFLICT WITH THE LAW
NAME OF GUARDIAN


GUARDIAN ADDRESS

HOME PHONE

MOBILE PHONE

ITEM C VICTIMS DATA
FAMILY NAME


FIRST NAME

MIDDLE NAME

QUALIFIER NICKNAME
CITIZENSHIP


SEX/GENDER

CIVIL STATUS DATE OF BIRTH (MM/DD/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE

CURRENT ADDRESS (HOUSE NUMBER/STREET)


VILLAGE/SITIO

BARANGAY

TOWN/CITY

PROVINCE

OTHER ADDRESS (HOUSE NUMBER/STREET)


VILLAGE/SITIO

BARANGAY

TOWN/CITY

PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT


OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)


ITEM D - NARRATIVE OF INCIDENT
TYPE OF INCIDENT DATE/TIME OF INCIDENT PLACE OF INCIDENT


ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING.




















































(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)
I HEREBY CERTIFY TO THE CORRECTNESS OF
THE FOREGOING TO THE BEST OF MY
KNOWLEDGE AND BELIEF.
NAME OF REPORTING PERSON SIGNATURE OF REPORTING PERSON
SUBSCRIBED AND SWORN TO BEFORE ME
NAME OF ADMINISTERING OFFICER (DUTY OFFICER)


SIGNATURE OF ADMINISTERING OFFICER (DUTY OFFICER)
RANK, NAME AND DESIGNATION OF POLICE OFFICER (WHETHER HE/SHE IS THE DUTY INVESTIGATOR,
INVESTIGATOR ON CASE OR THE ASSISTING POLICE OFFICER)

SIGNATURE OF DUTY INVESTIGATOR/INVESTIGATOR ON CASE/ASSISTING
POLICE OFFICER

INCIDENT RECORDED IN THE BLOTTER BY:
RANK/NAME OF DESK OFFICER: SIGNATURE OF DESK OFFICER: BLOTTER ENTRY NR:



REMINDER TO REPORTING PERSON
Keep the copy of this Incident Record Form (IRF). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRF. For your reference, the data below is the contact details of this police station.

Name of Police Station Telephone
Investigator-on-Case Mobile Phone
Name of Chief/Head of
Office
Mobile Phone

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