DJJ Form ADSD-0009 "Protective Action Response Performance Evaluation - Par Instructors" - Florida

Form ADSD-0009 or the "Protective Action Response Performance Evaluation - Par Instructors" is a form issued by the Florida Department of Juvenile Justice.

Download a PDF version of the Form ADSD-0009 down below or find it on the Florida Department of Juvenile Justice Forms website.

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Download DJJ Form ADSD-0009 "Protective Action Response Performance Evaluation - Par Instructors" - Florida

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ADSD-009
q Attempt 1 q Attempt 2
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Protective Action Response Performance Evaluation –
PAR Instructors
-- PLEASE, NO ABBREVIATIONS. --
First
M.I.
Last
Last 5 digits SSN:
-________
Company Name:
Telephone: (
)
Facility Name:
Work Address:
City:
Zip:
Region (Circle one):
North
Central
South
Circuit:
E-Mail:
Fax: (
)
County:
Training Location:
Date of Evaluation:
/
/
q
q
PAR Train-the -Trainer
PAR Instructor Certification Renewal
NOTE: An explanation of how each technique is to be performed must be verbalized during demonstration of the technique.
Demo 1
Demo 2
Remedial
TECHNIQUES
COMMENTS
P/N
P/N
P/N
STANCE & BODY MOVEMENT
1. Reactionary Gap
2. Danger Zone
3. Interview Stance
4. Ready Stance
5. Approach (Using 45-Degree Angle)
COUNTERMOVES – Blocks
6. High Block
7. Mid-Range – Straight Arm Blows
8. Mid-Range – Roundhouse Blows
9. Low Block – “X” Block
10. Low Block – Leg Raise
COUNTERMOVES – Evasive
11. Evasive Sidestep
12. Evasive Sidestep w/ Redirection
COUNTERMOVES – Releases
13. One Wrist / Forearm Grab Release
14. Two Wrist / Forearm Grab Release
15. Rear Two Hand Release
16. Two Hands Together Grab Release
17. Front Choke Backstroke Release
18. Front Choke Wrist Release
19. Rear Bear Hug Release
20. Front Bear Hug Release
PAR Performance Evaluation – PAR Instructors (Revised 12/11/2006)
Page 1 of 4
ADSD-009
q Attempt 1 q Attempt 2
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Protective Action Response Performance Evaluation –
PAR Instructors
-- PLEASE, NO ABBREVIATIONS. --
First
M.I.
Last
Last 5 digits SSN:
-________
Company Name:
Telephone: (
)
Facility Name:
Work Address:
City:
Zip:
Region (Circle one):
North
Central
South
Circuit:
E-Mail:
Fax: (
)
County:
Training Location:
Date of Evaluation:
/
/
q
q
PAR Train-the -Trainer
PAR Instructor Certification Renewal
NOTE: An explanation of how each technique is to be performed must be verbalized during demonstration of the technique.
Demo 1
Demo 2
Remedial
TECHNIQUES
COMMENTS
P/N
P/N
P/N
STANCE & BODY MOVEMENT
1. Reactionary Gap
2. Danger Zone
3. Interview Stance
4. Ready Stance
5. Approach (Using 45-Degree Angle)
COUNTERMOVES – Blocks
6. High Block
7. Mid-Range – Straight Arm Blows
8. Mid-Range – Roundhouse Blows
9. Low Block – “X” Block
10. Low Block – Leg Raise
COUNTERMOVES – Evasive
11. Evasive Sidestep
12. Evasive Sidestep w/ Redirection
COUNTERMOVES – Releases
13. One Wrist / Forearm Grab Release
14. Two Wrist / Forearm Grab Release
15. Rear Two Hand Release
16. Two Hands Together Grab Release
17. Front Choke Backstroke Release
18. Front Choke Wrist Release
19. Rear Bear Hug Release
20. Front Bear Hug Release
PAR Performance Evaluation – PAR Instructors (Revised 12/11/2006)
Page 1 of 4
ADSD-009
Participant’s Name: __________________________________________________________ q Attempt 1 q Attempt 2
Demo 1
Demo 2
Remedial
TECHNIQUES
COMMENTS
P/N
P/N
P/N
COUNTERMOVES – Escapes
21. Bite Escape
22. Headlock Escape
23. Full Nelson Escape
24. Double Arm Lock Escape
25. Front Hairpull Escape
26. Rear Hairpull Escape
COUNTERMOVES – Defense & Control
27. Ground Defense
TOUCH
28. (a) Straight Arm Escort: Extended
(b) Straight Arm Escort: Close
29. Supportive Hold: Stage 1
CONTROL TECHNIQUES
30. Ground Control
31. Baskethold
32. Arm Bar
33. Arm Control
34. Wrap-Around
35. Team Arm Control
36. Supportive Hold Control: Stage 2
37. Supportive Hold Control: Stage 3
PAR Performance Evaluation – PAR Instructors (Revised 12/11/2006)
Page 2 of 4
ADSD-009
Participant’s Name: __________________________________________________________ q Attempt 1 q Attempt 2
Demo 1
Demo 2
Remedial
TECHNIQUES
COMMENTS
P/N
P/N
P/N
TAKEDOWNS
38. Straight Arm to a Takedown
39. Baskethold to a Takedown
40. Arm Bar to Takedown
41. Wrap-Around:
Team Takedown
42. Supportive Hold Takedown: Stage 4
43. Supportive Hold Takedown: Stage 5
44. Immediate Team Takedown
SEARCHES (Participant selects at least one search technique.)
45. Person Search (Hands on Head)
46. Person Search (Hands Cuffed – Rear)
47. Person Search (Hands on Wall)
MECHANICAL RESTRAINTS (Front Cuffing)
48. (a) Standing Front Handcuffing
(b) Standing Front Uncuffing
49. (a) Waist Chain (Application)
(b) Waist Chain (Removal)
50. (a) Restraint Belt (Application)
(b) Restraint Belt (Removal)
51. Flex Cuffs
MECHANICAL RESTRAINTS (Rear Cuffing)
52. (a) Standing Rear Handcuffing
(b) Standing Rear Uncuffing
53. Prone Handcuffing
PAR Performance Evaluation – PAR Instructors (Revised 12/11/2006)
Page 3 of 4
ADSD-009
Participant’s Name: __________________________________________________________ q Attempt 1 q Attempt 2
Demo 1
Demo 2
Remedial
TECHNIQUES
COMMENTS
P/N
P/N
P/N
MECHANICAL RESTRAINTS
55. (a) Leg Cuffing (Kneeling Position)
(b) Leg Uncuffing (Kneeling Position)
56. (a) Leg Cuffing (Hands on Wall)
(b) Leg Uncuffing (Hands on Wall)
Comments (attach additional pages, if necessary):
§
Specify the number of “Not Proficient” techniques in the “Demo 2” column. _____
§
If applicable, specify the number of “Not Proficient” techniques in the “Remedial” column. _____
q
q
§
Upon conclusion of this evaluation session; i.e., “attempt,” the participant: PASSED?
? ? ? FAILED
1.
2.
nd
Master PAR Instructor’s Printed Name & Initials (Required)
2
Evaluator’s Printed Name & Initials (Required)
3.
4.
rd
th
3
Evaluator’s Printed Name & Initials (If Necessary)
4
Evaluator’s Printed Name & Initials (If Necessary)
This evaluation has been reviewed and discussed.
Participant’s Signature
PAR Performance Evaluation – PAR Instructors (Revised 12/11/2006)
Page 4 of 4
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