Investor Presentaiton

Previous perpetrator of violence in the past month Previous victim of violence in the past month Life Events: Physical fight (2 people) Argument Timing of Argument:- Previous Exposure to Violence: Abuse or neglect led to death History of abuse a child neglect as Crime and Criminal Activity: Precipitated by another crime Crime(s) Type: Prostitution or sex trafficking First crime in progress Stalking Gang related ப Terrorist attack ☐ Walk-by assault ☐ Circumstances - Complete the following for HOMICIDE & LEGAL INTERVENTION Deaths only Justifiable self defense ☐ Victim was a police officer on duty Mercy killing Hate crime ☐ Victim was a bystander ☐ Jealousy (lover's triangle) Random violence ☐ physical fight) Victim was an intervener ☐ Drive-by shooting Brawl (3 people or mare in a ☐ Victim used a weapon ☐ Drug involvement L Circumstances - Complete the following for SUICIDE & UNDETERMINED Deaths only Π Crisis Variables: These should be endorsed when the circumstance was noted to have occurred/or worsened 2 weeks prior to death History of suicide Contributing physical ☐ Civil legal problems Crisis ☐ ☐ Crisis attempts Disclosed suicidal thoughts Contributing criminal Crisis ☐ health problem Job problem ☐ Crisis or intent to commit suicide legal problem ☐ To whom Financial problem Crisis L School problem ☐ Crisis Left a suicide note ப Suicide of friend or family Crisis ப Eviction or loss of home History of expressed suicidal thoughts or ☐ Non-suicide death of friend or family Crisis ☐ Disaster exposure ☐ ☐ Crisis Crisis ☐ plans Anniversary of a ☐ traumatic event Brief Narrative of the Incident or See Attached Context of Injury Hunting Playing with gun Target shooting ☐ Other context of injury Self-defensive shooting Loading or unloading gun Circumstances - Complete the following for UNINTENTIONAL/ACCIDENTAL FIREARM DEATHS only: Mechanism and Context of Injury: Endorse any/all circumstances that apply to the situation and actions that led to the unintentional firearm injury Celebratory firing Showing gun to ☐ others Cleaning Gun Mechanism of Injury Thought safety was engaged Bullet ricochet П Fired while operating ☐ safety/lock Thought gun was unloaded ☐ Gun defect or malfunction Gun mistaken for toy Fired while holstering/ Unintentionally pulled trigger Dropped gun ☐ ☐ Other mechanism of injury ☐ ☐ unholstering ☐ Page 3 of 4 CoVDRS Data Abstraction Form-Version 2018.09 CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment Additional Comments: Page 4 of 4 CoVDRS Data Abstraction Form - Version 2018.09 54 54

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