Sample surveillance report

Case:

• Claim No.: QR-123456HI Mr. John Doe.
• Client Insured: All Hawaii Co. NATIONAL INSURANCE
• Date of Loss: May 6, 20**
• Place: Honolulu, HI 96814
• Claimant: John Doe
• Our File No.: HI-0123
• Investigator(s): QR
• Report Date: Augst 27, 20**

SYNOPSIS
It was confirmed that Doe resides at 1234 ********* ST, Honolulu, HI. He drives a 20** Pontiac convertible, apparently purchased after his accident of March 6, 20**.

Doe has no known employment, but is apparently active around his house, as documented through observation.
He exhibited no signs of pain or movement restrictions. He walked in a normal manner at a normal gait.
He appeared to have no difficulty ascending or descending steps, or with entering into or alighting from his car.

REPORT OF SURVEILLANCE
Pursuant to client request, commenced surveillance of John Doe, 1234 ********** St, Honolulu, HI, to determine his current activities following an injury he suffered on March 6, 20**.

August 27, 20**:

6:00 a.m.:
Investigator arrived in the vicinity of 1234 ********* ST, Honolulu, HI to commence surveillance of subject John Doe.
Upon arriving in the area, it was noted that Doe’s residence is situated in a redominately white, middle-class, residential neighborhood consisting of single-family, one-story, brick residences located on a paved and curbed street.

The Doe residence was found to be located on the north side of *********** ST, the third house west of ********** ST’s intersection with ******** Road. The residence was of red brick construction, with a brown, asbestos shingle roof, and wood trim painted beige. Situated on the right side of the house were a double-car garage and a double-car concrete driveway.

Parked in the driveway was a car described as:
White over red, 2007 Pontiac, two-door convertible, bearing Hawaii license plates ABC-123
(John J. Doe, 1234 ********** ST, Honolulu, HI registered this vehicle, on June 16, 20***. The lien-holder is Alamo Vehicle Sellers, Honolulu, HI).

Parked in the street in front of the residence was a car
described as:
Yellow 1986 Oldsmobile Cutlass, two-door coupe, bearing Hawaii license plates XYX-333
(This vehicle is registered to John Doe, Jr., 1234 ******** ST, Honolulu, HI. The title was issued on May 7, 20**. There is no lien-holder).

The Doe residence was found to be in a well-maintained condition. The yard was freshly mowed and a large flowerbed ran the length of the front of the house. The bed was filled with numerous blooming annual flowers. It also appeared to be well maintained. It was obvious that roof shingles had recently been replaced on the residence.

Surveillance was established from a position that afforded an excellent observation of the front of the Doe residence, and of the two vehicles parked at the residence.

8:03 a.m.:
A person, described as:
male/white, age 40-45, 5’7″, 160 lbs.,average build, medium complexion, short
dark hair, mustache, wearing a blue baseball cap, white T-shirt, blue jeans, and white
tennis shoes
believed to be John Doe, and hereafter referred to as the subject, exited the ********** house from the front door and walked down the three steps from the porch.
He entered the driver’s side of the Pontiac and closed the door.
He then backed the Pontiac into the street and departed in a westerly direction on ******** ST.

Investigator’s Note:
The subject’s movements, although only seen in a limited manner, appeared to be fluid and normal.
No movement restrictions were noted.

8:11 a.m.:
Subject arrived at the Grand Junction Convenience Store, located on the corner of ********* ST and *********** Lane. He parked his Pontiac in the parking lot in front of the store, alighted from the vehicle and entered the store.

8:13 a.m.:
The subject exited the store and walked back to the Pontiac, carrying a one-gallon container of milk in his left hand.
The milk was hanging at the bottom of his fully extended left arm, which hung alongside his body.
The subject opened the door of the Pontiac using his right hand and pulled it open.
He then bent forward at his waist and placed the milk on the left, rear floor of the car.
He straightened up, swiveled to his left and placed his right foot onto the front driver’s floor of the car and “flopped” his body into the car.
He then swung his left leg into the car and closed the door with his left arm. All movements appeared normal and unrestricted.
Subject drove away in an easterly direction on Waimanu ST.

8:20 a.m.:
Subject arrived at his residence, parking the Pontiac in the driveway, bisecting the concrete sidewalk, which runs parallel to the street.
He alighted from the car and walked into the house after ascending the three concrete steps in front of the house.
All movements again appeared normal.

8:47 a.m.:
Subject walked from the eastside of the house carrying an aluminum extension ladder with his left
arm.
His right arm was extended in a downward fashion, but at about a 45-degree angle away from his body, as if to provide balance.
He placed the ladder in an upright position in front of the house, near the southeast corner.
He extended the ladder upward so that its length was about three feet above the edge of the roof. He then walked around the house out of sight.

8:51 a.m.:
Subject again walked from the eastside of the house, this time carrying a hammer.
He climbed the ladder, holding the hammer in his left hand while using his right
hand to stabilize himself as he climbed the ladder, one foot over the other.
At the roof’s edge, he hammered down a guide wire that led to his television antenna mast.
After securing the guide wire and checking the tension on it with his right hand, he climbed down the ladder.
He hung the hammer on his belt and pulled the ladder away from the house.
He then used the pull ropes on the ladder to unhook the two sections of the ladder, and then lowered the upper extension downward, so that both sections were parallel.
As he did this, he held his head back looking upward. His back was arched in a backward angle. After completing this task, he allowed the ladder to gently fall downward so that its length was horizontal with the ground.
He then carried the ladder with his right hand while his left arm was extended at a 45-degree angle away from his body. He disappeared from sight around the house.

11:17 a.m.:
A person, described as:
Male/white, age 18-20, 5’7″, 125 lbs., thin, light complexion, shoulder-length blonde hair,
wearing a red pull-over shirt, white shorts, and no shoes walked from the front door of the house to the yellow Oldsmobile.
He entered the car and drove away.

2:10 p.m.:
An Anderson’s Department Store delivery van arrived at the subject’s residence.
The female driver delivered a small package to the subject’s front door. It could not be seen who accepted delivery. The van and its driver then departed.

5:00 p.m.:
Surveillance was discontinued.

Investigator’s Note:
All movements exhibited by Doe appeared normal.
There was no indication of movement restriction in his walk, while entering into or alighting from his car, while climbing up or down the ladder, or while carrying any of the items he was observed to carry.
All movements appeared fluid, and of normal speed.
No signs of distress or pain were observed on the subject’s face.

Supervisor’s Note:
This concludes the work authorized by client. Should client desire, we can perform any or all of the following work to obtain additional information pertinent to Doe:

1. Interview neighbors to determine whether Doe put the new roof on his house himself or whether he had it done. We could also attempt to determine from the neighbors whether Doe performs his own yard work, et cetera.
2. Conduct additional surveillance of Doe to further document his activities.

VIDEOTAPE LOG
RE: SUBJECT: John Doe
INVESTIGATOR: QR
APPROXIMATELY 5 MINUTES AND 20 SECONDS OF VIDEOTAPE WAS TAKEN OF THE
ABOVE SUBJECT TODAY, AS FOLLOWS:
8:13 a.m.: Subject walking from Grand Junction
Convenience Store to his car, and entering it.
8:20 a.m.: Subject walking from his car into his house.
8:47 a.m.: Subject carrying a ladder, placing it in front of his house, and walking out of sight.
8:51 a.m.: Subject walking from around his house, climbing a ladder, hammering an antenna mast guide wire down, descending the ladder, and carrying ladder back around house.

NOTE:
ALL TIMES LISTED ABOVE ARE CLOSE APPROXIMATIONS.

CAUTION:
THE ABOVE-DELINEATED FILM IS BELIEVED TO BE OF THE
SUBJECT OF THIS INVESTIGATION, BASED ON DESCRIPTIONS,
RESIDENCE ADDRESS, VEHICLE OWNERSHIP, AND/OR OTHER
FACTORS.
IF CLIENT IS NOT FAMILIAR WITH THE SUBJECT, IT MAY BE ADVISABLE FOR POSITIVE CONFIRMATION OF IDENTITY TO BE ESTABLISHED. WE WILL BE PLEASED TO ACCOMPLISH SAME UPON CLIENT REQUEST.

PHOTOGRAPH LOG
RE: SUBJECT: John Doe
INVESTIGATOR: QR
THE FOLLOWING PHOTOGRAPHS WERE TAKEN OF THE ABOVE SUBJECT TODAY, AS FOLLOWS:
8:03 a.m.: Subject walking from his house to his car. (4 photos)
8:11 a.m.: Subject walking from his car to Grand
Junction Convenience Store. ( 2 photos)

NOTE:
ALL TIMES LISTED ABOVE ARE CLOSE APPROXIMATIONS.

CAUTION:

THE ABOVE-DELINEATED PICTURES ARE BELIEVED TO BE OF THE SUBJECT OF THIS INVESTIGATION, BASED ON DESCRIPTIONS, RESIDENCE ADDRESS, VEHICLE OWNERSHIP,AND/OR OTHER FACTORS. IF CLIENT IS NOT FAMILIAR WITH THE SUBJECT, IT MAY BE ADVISABLE FOR POSITIVE CONFIRMATION OF IDENTITY TO BE ESTABLISHED. WE WILL BE PLEASED TO ACCOMPLISH SAME UPON CLIENT REQUEST.

Investigative Agency:
QiQ Research, Inc.
Professional Investigative Services
1953 S.Beretania ST PH-C, Honolulu HI 96826 USA
Phone: (808) 377 – 4500
Fax: (808) 356-1638