Department Complaint Form

Complaining Person/Officer
ID # (if applicable)
Rank (if applicable)
Nature of Complaint
Supervisor Reported To
Employee to be Complained Against
Rank
ID #
Cruiser #
Name and Address of Victim (if any)
Date of Incident
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
Location of Incident
Name of Witness
Witness' Address
Street Address Address Line 2 City State ZIP Code
Witness' Telephone
Name of Witness
Witness' Address
Street Address Address Line 2 City State ZIP Code
Witness' Telephone
Description of Incident
Your Name
Email
Consent*
I truly declare and affirm that the statements contained herein are accurate and complete to the best of my knowledge and belief. I understand that my cooperation with any internal investigation is governed by Department Rules and Regulations 10.10.