Death Investigation Checklist Disclaimer:This form is not intended to replace the need to write a general or supplemental police report.General InformationReport Number Location Police Notified:Date MM slash DD slash YYYY Time Hours : Minutes Time Arrived on Scene Hours : Minutes Hospital Name Pronouncing Doctor Time Pronounced Hours : Minutes Responding AmbulanceUnit Number Investigating OfficerName Badge Evidence Technician(if needed)Name Badge Supervisor NotifiedName Badge Time Hours : Minutes MID Notified(if needed)Name Badge Time Hours : Minutes Decedent Information:Decedent’s: Full Name Sex— Make a Selection —FemaleMaleUnknownRace— Make a Selection —Am In/AlaskanAsianBlackMulti-RacialUnknownWhiteDate of Birth Month Day Year Age DL/ID Number Hair— Make a Selection —AuburnBaldBlackBlondeBrownGrayOtherRedWhiteEyes— Make a Selection —BlackBlueBrownGrayGreenHazelMaroonMulticolorPinkUnknownHeight Weight Scars, Marks, Tattoos Home Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone NumberWork Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work Phone NumberPrimary Physician’sName Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberCurrent Medical History Prescription Medicines Religious Denomination Church & PastorName Phone NumberRelative(s)Name Sex— Make a Selection —FemaleMaleUnknownRace— Make a Selection —Am In/AlaskanAsianBlackMulti-RacialUnknownWhiteDate of Birth Month Day Year Relationship Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberNotified By:Name Badge Time Hours : Minutes Add Relative Check here to add a 2nd relative Name Sex— Make a Selection —FemaleMaleUnknownRace— Make a Selection —Am In/AlaskanAsianBlackMulti-RacialUnknownWhiteDate of Birth Month Day Year Relationship Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberNotified By:Name Badge Time Hours : Minutes AM PM AM/PM Funeral Home Preference Disposition of Dwelling(Turned over/Secured/Boarded Up, Etc.) Corner/Medical Examiner Information Kane County 0900 – 1700: 630-232-3535 Kane County After Hours: 630-232-8400 Cook County 0900 – 1700: 312-666-0500 Cook County After Hours: 312-666-0200 Coroner:Contacted Name Time Contacted Hours : Minutes On Scene Name Body Released By Time Released Hours : Minutes Body Removed By Time of Removal Hours : Minutes AM PM AM/PM InvestigationWhat was the decedent doing at the time of death? Who found the body? Why were they there? Other People at the scene? Was there forced entry or anything suspicious observed? Enter your email address to receive a copy of this form:(Required)