DJJ Form ADSD-008 "Protective Action Response Performance Evaluation - Program Staff" - Florida

What Is DJJ Form ADSD-008?

This is a legal form that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 15, 2003;
  • The latest edition provided by the Florida Department of Juvenile Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DJJ Form ADSD-008 by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Download DJJ Form ADSD-008 "Protective Action Response Performance Evaluation - Program Staff" - Florida

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ADSD-008
Attempt 1
Attempt 2
Attempt 3
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Protective Action Response Performance Evaluation – Program Staff
-- PLEASE, NO ABBREVIATIONS. --
First
M.I.
Last
Last 5 digits SSN: __-
Company Name:
State-Operated
Contracted
Work Address:
City:
Zip:
Region: North Central
South
Circuit:
Unit #:
County:
Training Location:
Date of Evaluation:
/
/
(Check, if applicable.) This participant is on Medical Status.
NOTE: Verbal direction must be used for all techniques except Reactionary Gap, Danger Zone, and Interview Stance.
Demo 1
Demo 2
Remedial
TECHNIQUES
COMMENTS
S/U
S/U
S/U
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
PAR Performance Evaluation – Program Staff (8/15/03
)
Page 1 of 2
ADSD-008
Attempt 1
Attempt 2
Attempt 3
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Protective Action Response Performance Evaluation – Program Staff
-- PLEASE, NO ABBREVIATIONS. --
First
M.I.
Last
Last 5 digits SSN: __-
Company Name:
State-Operated
Contracted
Work Address:
City:
Zip:
Region: North Central
South
Circuit:
Unit #:
County:
Training Location:
Date of Evaluation:
/
/
(Check, if applicable.) This participant is on Medical Status.
NOTE: Verbal direction must be used for all techniques except Reactionary Gap, Danger Zone, and Interview Stance.
Demo 1
Demo 2
Remedial
TECHNIQUES
COMMENTS
S/U
S/U
S/U
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
PAR Performance Evaluation – Program Staff (8/15/03
)
Page 1 of 2
ADSD-008
Participant’s Name: ________________________________________________
Attempt 1
Attempt 2
Attempt 3
Demo 1
Demo 2
Remedial
TECHNIQUES
COMMENTS
S/U
S/U
S/U
COUNTERMOVES – Releases
19. Rear Bear Hug Release
20. Front Bear Hug Release
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
27. Ground Defense
Comments (attach additional pages, if necessary):
Specify the number of unsatisfactory techniques in the “Demo 2” column. _____
Specify the number of unsatisfactory techniques in the “Remedial” column. _____
Upon conclusion of this evaluation session, the participant: PASSED
  
FAILED
1.
2.
nd
Evaluator’s Printed Name & Initials
2
Evaluator’s Printed Name & Initials, If Necessary
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 – Program Staff (8/15/03)
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