We ask this information so we can communicate effectively with Arrestees and/or Companions. All communication aids and services are provided FREE OF CHARGE. If you need further assistance, please ask [Arresting Officer, Desk Sergeant, or other Police Department Personnel.
Date:
Name of Arrestee or Companion:
Nature of Disability:
Deaf
Hard of Hearing
Speech Impairment
Other: __________________
Relationship to Arrestee:
Self
Family member
Friend
Other: ________________
Does the person with a disability want an onsite professional sign language or oral interpreter?
Yes. Choose one (free of charge):
American Sign Language (ASL)
Signed English
Oral interpreter
Other. Explain: _________________
No.
Which of the following would be helpful for the person with a disability? (free of charge)
TTY/TDD (text telephone)
Assistive listening device (sound amplifier)
Qualified note-takers
Writing back and forth
Other. Explain: __________________
If the person with a disability, or the Arrestee who the person with a disability is with, is
IN CUSTODY, which of the following should be provided for communication with Police Personnel, Family/Companion, and attorney?
Video remote interpreting
Telephone handset amplifier
Telephone compatible with hearing aid
TTY/TDD
Flasher for incoming calls
Paper and pen for writing notes
Other. Explain: __________________________________
Any questions?