victim identification programema.ohio.gov/documents/plans/vip_interview.pdf · victim...

Victim Identification Program

Family Interview

Ver. September 2016

of 8VIP Personal Information

RM #

Incident DateIncident

Rel

atio

nshi

p SpouseFatherMotherBrotherSisterSon

DaughterUncleAuntCousinEmployerFriend

Life PartnerOther,

E-mail

Info

rman

t

FirstLast MiddleSuffix

Address State Zip

Home Phone Work Phone Cell Phone

Initial Contact DateType of Initial Contact

Con

tact

s

City

Relationship Other:

Address

Home Phone

Rel

atio

nshi

p

,Last Middle

City State Zip

Cell PhoneWork Phone

OK to Contact Legal Next of Kin? Yes No

E-mailLega

l Nex

t of K

in

FirstSuffix

Relationship Other:

SpouseFatherMotherBrotherSisterSon

DaughterUncleAuntCousinEmployerFriend

Life PartnerOther

Country

Country

,

Make A Case Note To Explain

Relationship Other:

Rel

atio

nshi

p SpouseFatherMotherBrotherSisterSonDaughter

UncleAuntCousinEmployerFriendLife PartnerOther

Home Phone Work Phone Cell Phone

FirstLast MiddleSuffix

Address City State Zip

E-mail Initial Contact DateType of Initial Contact

YES

Additional Contact?YES

Permanent Contact (Can be reached anytime): /,

Place any additional Contacts on the back of this page and mark the box with an X

W CPhone / Home

Age/ /

If Married/Maiden NameBirth GenderFirst MiddleLast Suffix/

Education: Highest level completed: CollegeElem/Second (0-12): Degree Earned:

FirstLast Middle FirstLast Middle

Alias 1 Alias 2

Primary Citizenship

CountryCounty

Religious Preference

SSN # / ID #DOB MM/DD/YYYY

Birth City State or Country

Race

ZipAddress City StateApt #

If Hispanic: Ethnic Origin

Type: Provider:

Secondary Citizenship

If Hispanic: Other

Mother Living Deceased UnknownFirstLast MiddleMaiden/Birth Name

Status Wedding DateIs Married Never Married Widowed Divorced Separated Civil Union Unknown

Spouse Living Deceased UnknownFirstLast MiddleMaiden/Birth name

Father Living Deceased UnknownFirstLast MiddleSuffix

Suffix,

,

Location Side Tattoo Description#

Location Side Quantity Description (include evidence of old piercings)#

Page 2 of 8VIP Physical Description

/Middle

/FirstLast Suffix

/Age DOB Race

1

2

3

4

5

1

2

3

4

5

Yes No UnkBody Piercing(s)? Yes No Unk Photos? Photo Location

Tattoo(s) Yes No Unk Yes No Unk Photos? Photo Location

Hair Length BaldShaved

Short < 3"Medium

Male Pattern Baldness:Long > 3"

AuburnBlack

BlondeBrown

GrayRed

Salt / PepperWhite

DyedOther

Height Weight (Lbs):

Photo Available?

Extremely Long Long Medium ShortFingernail Type LengthNatural Artificial Unknown

Fingernail Color Description

Toenail Color Toenail description

Eye Color Blue Brown Green Gray Hazel Black Other:

Desc.None Contacts Glasses Corneal Implant ROptical Lens

Both Intact Missing R Missing L Glass R Glass L Cataract R Cataract LEye Status

Hair Color

BlondeBrown

BlackGray

RedSalt & Pepper

WhiteFacial HairColor

Facial Hair Notes:

Hair Accessory Extensions Hair Piece Hair Transplant Wig None

Hair Description Curly Wavy Straight Other:

Height cm Weight Kilos

Describe Other:

Describe Male Pattern Baldness:

Toenail Type Natural Artificial Unknown

Complexion: General Build:

Ft In Total / In

Hai

r Inf

oEy

esN

ails

Photo Available?

Birth Gender

RM #


Facial Hair BeardMustache

GoateeSideburns

StubbleLower Lip

Yes No Unknown Facial Hair Type

of 8VIP Medical History

/Middle

/FirstLast Suffix

/Age DOB Race

Braces Bridge Caps/Crowns Fillings Dentures Edentulous Tooth Jewelry Unknown

Dentist

Address City State Zip

Phone W2nd Dentist:

First Last

Fax

Sal

Dental Insurance Company:

E-mail Address:

Name of Practice:

Alt:

Den

tist

Physician

Address

City State Zip

Practice Name

EmailPhone H

Physician Type

Reason Seen:

Date Last Seen:

Fax

,

Phone W

Phone C

Phys

icia

n

Physician

Address

City State Zip

Practice Name

EmailPhone H

Physician Type

Fax

,

Phone W

Phone C

Birth Gender

RM #


First Last Sal.Middle

First Last Sal.Middle

Phys

icia

n

Diabetic? Yes No Unk If Female, was she currently pregnant? Yes No UnkIf Female, was she pregnant during the last 12 months? Yes No Unk

Circumcised ? Yes No Unk Tobacco User ? Yes No Unk Tobacco Type ?

Medical Facility Visited / Type?Medical Facility / Name

Medical Radiographs? Yes No UnkMedical Radiographs Location:Potential Type of Radiographs - and dates taken if known:

Prosthetic(s) Yes No Unk Prosthetic Location/Description:

Description of: Scars or unusual body features:

Unique Characteristics, Scars or Body Features: Yes No Unk

Yes No UnkOld Fractures: Description:Foreign Objects :

Surgery:

Pacemaker Bullets Implants Needles Shrapnel Other

Gall BladderAppendectomyTracheotomy

LaparotomyCaesareanMastectomy

ReconstructiveOpen heartOther

Yes No Unk

YesNoUnk

Describe Other:

Medical History? Broken Bones Cancer High Blood Pressure Lung Disease Pregnancy Stroke OtherMedical History Notes / Other?

Description of Other:

Gender Reasignment Surgery: Yes No Unk

Reason Seen:

Date Last Seen:

of 8VIP Personal Information

/Middle

/FirstLast Suffix

/Age DOB Race


Usual Occupation/Title:

Last seen with / where:

Traveling with:Alone Individual Group

Family, Sports, Church, Military, etc.

Ever Printed:Yes No Unk

Service Number Approximate Service DateBranchNation Served

DNA Taken:Yes No Unk

Location of Prints:

Criminal History:Yes No Unk

Arrested By:

Military ServiceYes No Unk

Prison or Jail Location:

Date last seen? Last seen by / relationship?

Print Types:

Date of Last Arrest: Date Released:

Work Status:

Comments regarding Military History:

MILITARY INFORMATION

CRIMINAL HISTORY OR FINGER PRINT INFORMATION

EMPLOYMENT HISTORY

GROUP TRAVEL INFORMATION

ADDITIONAL PERSONAL DATA

Family or Group Name:Group Type:

Comments:

Additional Data:

List memberships: Clubs, Fraternities, etc.

List Social Media used and user names: (Facebook, Twitter etc.)

Birth Gender

RM #

Employer:Type of Business / Industry:

Employer Address:

Employer Phone:

Stone Color1Material Color/

DescriptionJewelry/Type Size / Where Worn/

Frequently Worn?

Yes No

Yes No

Photo Available

Inscription

Style

Page 5 of 8VIP Jewelry

Stone Color?

/Middle

/FirstLast Suffix

/Age DOB Race



Frequently Worn?

Yes No

Yes No

Photo Available

Inscription

Style Stone Color?



Frequently Worn?

Yes No

Yes No

Photo Available

Inscription

Style Stone Color?



Frequently Worn?

Yes No

Yes No

Photo Available

Inscription

Style Stone Color?



Frequently Worn?

Yes No

Yes No

Photo Available

Inscription

Style Stone Color?



Frequently Worn?

Yes No

Yes No

Photo Available

Inscription

Style Stone Color?


Photo Available

Band Material Face Color

Description

Make

Inscription

Type

WA

TCH

:

YesNoUnk

Normally wears a Watch:Yes No Unk

Yes No Unk

Where Worn ?Band Color

JEW

ELR

Y:

Birth Gender

RM #

Normally wears Jewelry: Yes No Unk

CLO

THING:

Clothing Items Color Description Size

Page 6 of 8VIP Clothing and Personal Effects

/Middle

/FirstLast Suffix

/Age DOB Race


ContentsDescription

ContentsDescription

Wallet:

Purse:

Birth Gender

Contents Left

Contents Right

Pockets:

Fron

t

Rear

RM #

Primary donor for Nuclear DNA AnalysisAn “appropriate family member” for nuclear DNA Analysis is someone who is biologically related to and only one

generation removed from the deceased. The following are the family members who are appropriate donors to providereference specimens, and in the order of preference (family members highlighted in bold print are the most desirable):

1. Natural (Biological) Mother and Father, AND2. Spouse and Natural (Biological) Children, AND3. A Natural (Biological) Mother or Father and victim’s biological children, OR4. Multiple Full Siblings of the Victim (i.e., children from the same Mother and Father).

GenderLast Name First Name Middle Name DOB Relationship

Page 7 of 8VIP Family

/Middle

/FirstLast Suffix

/Age DOB Race


SS# Last 4Suffix

Potential Living Biological DonorsAll BIOLOGICAL Relatives of Missing Individual

Such as: Mother/Father/Sister/Brother/Children/Uncle/Aunt/Cousin

Birth Gender

Address City State Zip E-MailCell Phone

Explain if DNA NOT Collected:

GenderLast Name First Name Middle Name DOB RelationshipSS# Last 4Suffix















RM #

of 8 VIP Interviewer Information

/ /Possible Victim’s NameFirstLast Middle

DateInterview Location

Time

Interviewing Agency

Home Phone:

Interviewer Name

City:

(MM/DD/YYYY)

Full Name

Reviewer InfoReviewer Name:

Interviewer Home Information

Cell Phone:

Work Phone:

Interviewer Onsite InformationInterviewer Onsite address:

Interviewer Onsite phone:Interviewer Onsite cell:

Location Name and Street,City. State and Room #

Reviewing Agency:

Reviewer’s Signature:

RM #

victim identification programema.ohio.gov/documents/plans/vip_interview.pdf · victim...

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