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Cognitive Impairment Indicator Form

Cognitive Impairment Form

MM slash DD slash YYYY
Address

Physical Description

Gender
tattoos, birth marks etc.
Wears glasses?

Medical Information

Relevant Conditions

Emergency Contact

Name
Address
Name
Second Emergency Contact Name

Information Specific to Individual

movies, playgrounds etc.
Specific topics, toys, music, shows, etc
Bright lights, loud noises, etc
tablet, sign language etc.
Does the individual have a Project Lifesaver or LoJack Safety Net Transmitter Number, phone tracking device, etc.

Latest News

Blackstone Police Department Shares Safety Tips for National Water Safety Month

May is National Water Safety Month, a time dedicated to raising awareness about boating and swimming safety. According to the American Red Cross, about 4,000 people die from unintentional drowning each year, which is an average of 11 deaths per day. During 2023, the American Coast Guard reported 3,844 boating accidents that resulted in 564 deaths and 2,126 […]

Blackstone Police Department Commemorates National Police Week

National Police Week, which occurs this year between May 11 and 17, honors law enforcement officers who have given their lives in the line of duty. It is a time to recognize and pay homage to the sacrifices made to keep communities safe and an opportunity to support the colleagues and families of officers who have given their lives.

The National Law Enforcement Officers Memorial Fund reported that since the first recorded police death in 1786, there have been over 24,000 police officers killed in the line of duty. With over 800,000 law enforcement officers currently serving in the United States, there are plenty of people to thank for protecting our communities.

During this week, please extend your appreciation to local police officers by thanking them for their duty, or show gratitude to those who lost their lives in service by attending a local memorial service.

Blackstone Police Department Recognizes National Mental Health Month

National Mental Health Month, observed each May, promotes mental wellness through an annual theme. Mental Health America’s theme for 2025 is “Turn Awareness into Action.” This initiative encourages people to recognize the strides that have been made in decreasing the stigma around mental health, while also working to transform this understanding into actions to create change. According to Mental […]

In partnership with our community, the Blackstone Police Department strives to provide the highest quality of protection, safety and well being for all of our residents, businesses and visitors. In furtherance of this goal, our Department implements a proactive approach in the prevention, detection and investigation of criminal activity. The most vital tool available to us is the assistance, involvement and interaction of the citizens we have pledged to serve. It is our hope that this webpage may serve as a bridge between the community and the police department, allowing a free exchange of information, ideas, and feedback, in order to create safer neighborhoods and foster public trust in our department.