SHOTGUN TEST FORM CJT 728
PRIVATE SECURITY GUARDS/PRIVATE INVESTIGATORS/ BAIL RECOVERY AGENTS
UPDATED 1/2015 / Complete and return with WSCJTC form 726 to the following address:
Washington State Criminal Justice Training Commission
19010 First Avenue South
Burien, WA 98148
INSTRUCTOR AND STUDENT INFORMATION
RANGE/LOCATION / SHOOTERS NAME (PRINT)
INSTRUCTOR NAME (PRINT) / SHOOTERS SIGNATURE
INSTRUCTOR SIGNATURE / INSTRUCTOR PHONE
INSTRUCTOR EMPLOYER / INSTRUCTOR EMAIL
SHOTGUN SKILLS AND SAFETY TEST
INSTRUCTIONS FOR SKILLS AND SAFETY TEST
  The individual being tested must demonstrate each skill to qualify. This is a pass/fail test that should be conducted in the range, one-on-one, so that the instructor can verify each skill.
  The individual should report to the firing line with the shotgun unloaded, action open, safety on, with the gun slung on the shoulder or carried with the muzzle high and pointed in a safe direction.
  The instructor will ask the individual to perform the following activities. As the individual performs the training exercises, the instructor shall mark off each box showing that the exercises have been completed.
1.
Bring the gun from safe carry to shoulder, low ready position
Finger off the trigger
Muzzle pointed in safe direction
Low ready correctly demonstrated with muzzle about 45%
2.
Duty loads the shotgun with the gun on the shoulder, chamber closed, and safety on (no round in chamber).
Finger off the trigger
Muzzle pointed in safe direction
Gun stays on shoulder, held by strong hand
Loads with weak hand
3.
With gun at low ready, the shooter will move forward about 10 yards
Finger off the trigger
Muzzle pointed in a safe direction
Low ready correctly demonstrated with muzzle pointed down at about 45%
Gun stays on shoulder
4.
Unload gun for inspection
Finger off the trigger
Muzzle pointed in a safe direction
Action partially open during unload
Rounds not chambered during unload
Leaves action open
5.
Bring gun to safe carry position: sling, or pocket carry, muzzle high
Finger off the trigger
Muzzle pointed in a safe direction
Action remains open
Safe sling or carry position
SHOTGUN USED FOR CERTIFICATION
SHOTGUN MAKE ______MODEL ______CALIBER ______
AMMUNITION CALIBER (IF DIFFERENT THAN FIREARM CALIBER) ______
SHOTGUN QUALIFICATION COURSE
DISTANCE / DESCRIPTION / SHOTS / TIME / REQUIRED / ACTUAL
25 Yards / From ready position, fire 2 rounds (slug). / 2 / 10 sec / 100% on silhouette
15 Yards / From ready position, load 2; fire a total of 4 rounds (slug or buck, shooter’s choice). / 4 / 18 sec / 100% on silhouette
7 Yards / From ready position, load 2; fire a total of 4 rounds (buckshot). / 4 / 12 sec / 100% on silhouette
5 Yards / From ready position, load 2; fire a total of 4 rounds (buckshot). / 4 / 10 sec / 100% on silhouette
3 Yards / From ready position, fire 2 rounds. / 2 / 2 sec / 100% on silhouette
FINAL RESULTS / TOTAL SCORE:
SKILLS AND SAFETY TEST / PASSED / FAILED
QUALIFICATION COURSE / PASSED / FAILED
SHOOTER LAST NAME: / INSTRUCTOR INITIALS:
DATE OF TEST: