Incident information
|
Incident ID number |
Incident status |
Incident narrative |
Number of non-fatally shot persons in incident |
Number of persons, weapons |
Person information
|
Person type (victim or suspect) |
Name |
Social security number |
Age, date of birth |
Sex |
Race categories |
Ethnicity |
Residential address |
Person information (victim only)
|
Death certificate variables:
|
Birth place |
Veteran status |
Marital status |
Place of death |
Date of death |
State of death |
Cause of death (text) |
Underlying cause of death (ICD-10* code) |
Multiple condition codes |
Autopsy performed |
Pregnant |
Manner of death |
Date, time of injury |
Type of location of incident |
Injured at work |
Injury address |
Survival time |
Education |
Usual occupation, industry |
Toxicology variables (victim only)
|
Date, time specimens collected |
Alcohol testing |
Blood alcohol level |
Drug testing:
|
Amphetamines |
Antidepressants |
Cocaine |
Marijuana |
Opiates |
Other drugs |
Other victim variables
|
Number of wounds, bullets |
Location of wounds |
At person’s home |
Homeless status |
Victim in custody when injured |
Intoxication suspected |
Death type |
Supplementary Homicide Report (SHR)
|
SHR circumstance |
SHR situation |
SHR homicide type |
SHR justifiable homicide circumstance |
SHR victim-suspect relationship |
Victim-suspect relationship
|
Victim-suspect relationship |
Suspect was caretaker of victim |
Evidence of ongoing abuse |
Weapon variables
|
Weapon type |
Firearm variables:
|
Firearm information known |
Evidence recovered (gun, bullet, casing) |
Firearm type |
Make, model |
Cartridge specification |
Caliber, gauge |
Firearm serial number |
Firearm stolen |
Relationship to gun owner |
Gun stored locked; loaded |
Poison variables:
|
Type of poison |
Poison code |
Patient drug obtained for |
Size of pill (mg) |
Number of pills (upper, lower bound) |
Estimated amount of liquid poison ingested (ml) |
Carbon monoxide source, if carbon monoxide |
Weapon-person table
|
(Identifies which weapon killed the victim and which suspect used the weapon) |
Suicide circumstances
|
Mental health variables:
|
Current depressed mood |
Current mental health problem |
Diagnoses |
Treatment for mental illness (current, ever) |
Alcohol problem, substance problem |
Disclosed intent |
History of suicide attempts |
Precipitating circumstance:
|
Physical health problem |
Intimate partner problem |
Other relationship problem |
Job problem |
School problem |
Financial problem |
Recent suicide of friend or family |
Other death of friend or family |
Recent criminal problem |
Other legal problems |
Perpetrator of interpersonal violence |
Victim of interpersonal violence |
Crisis in past two weeks |
Other |
Homicide circumstances
|
Argument over money/property |
Jealousy (lovers’ triangle) |
Intimate partner violence related |
Other argument, abuse, conflict |
Drug related |
Gang related |
Associated with another crime |
Type of crime; crime in progress? |
Justifiable homicide |
Hate crime |
Brawl (mutual physical fight) |
Terrorist attack |
Victim was a bystander |
Victim was a police officer on duty |
Victim used weapon |
Intervener assisting crime victim |
Mercy killing |
Other |
Unintentional circumstance (firearm death)
|
Context:
|
Hunting |
Target shooting |
Self defensive shooting |
Celebratory firing |
Loading/unloading gun |
Cleaning gun |
Showing gun to others |
Playing with gun |
Other |
Mechanism:
|
Thought safety was engaged |
Thought unloaded: magazine disengaged |
Thought gun was unloaded, other |
Unintentionally pulled trigger |
Bullet ricochet |
Gun defect or malfunction |
Fired while holstering/unholstering |
Dropped gun |
Fired while operating safety/lock |
Gun mistaken for toy |
Other |
Child fatality review (CFR) module
|
Incident variables
|
Scene investigation by law enforcement; coroners/medical examiners |
Witnesses to incident; child witnesses |
Victim variables
|
CFR records available on victim |
Household information:
|
Type of residence |
New placement |
Adults in household (relationship to victim) |
Other children in household |
Intimate partner violence in household |
Substance abuse in household |
Primary caregivers (information collected on up to two parents or caregivers):
|
Victim or suspect in this incident |
Relationship to victim |
Age, sex |
Legal custody of victim |
History of child maltreatment as perpetrator |
Previous child death |
Supervision at the time of incident:
|
Supervisor relationship to victim |
Supervisor age, sex |
Quality of supervision contributed to child death |
Contributory factors |
Victim health information:
|
Physical illness |
Disability (physical, developmental, sensory) |
Prenatal care (infants) |
Prenatal drug, alcohol, tobacco use (infants) |
Child protective services contacts:
|
Report ever filed on victim’s household |
If so, on whom? |
Any report substantiated? |
If yes, type: physical, sexual, and/or neglect |
Case opened on other children? |
Additional suicide circumstances:
|
History of inpatient psychiatric treatment |
Taking psychiatric medication |
Barriers to accessing mental health care |
Suspect information:
|
Suspect identified by name |
Arrested as perpetrator in this death |
Charged |
Prosecuted |
Convicted |
Child protective services report ever filed on the suspect |
Ever charged with prior homicide |
Other prior system contacts by victim:
|
Police, juvenile justice, healthcare system, mental health, social services, welfare, Women, Infants, and Children, Medicaid |
Data sources used by CFR:
|
Coroner/medical examiner, social services/child protective services, law enforcement, school, emergency medical service, medical, public health, mental health, juvenile justice, death certificate |
CFR committee decisions:
|
CFR manner matches official manner of death |
CFR manner of death |
Action taken to change official manner? |
Result of action |
Preventable death |