Police Department Complaint Form

Instructions: Prepare this report in your own words. The Chief of Police or an investigating officer will contact you relative to the investigation of your complaint. If you need assistance in completing this report, please contact the on-duty supervisor.

Complainant

First Name:

Middle Name:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Work Phone:

Witness(es)

Name of First Witness:

Relationship:

Phone Number:

Address:

Name of Second Witness:

Relationship:

Phone Number:

Address:

Name of Third Witness:

Relationship:

Phone Number:

Address:

Complaint Details

Name of the employee you are filling a complaint against (if unknown provide a description of the employee):

Date of Occurance:

Time of Occurrence:

Location of Occurance:

Details of Complaint:

I hereby certify that information in this complaint is true to the best of my knowledge:

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