Civilian Complaint Report

INSTRUCTIONS: The on-duty supervisor will assist the complainant in completing the appropriate portions of this form in any complaint alleging misconduct by a member of this department. He/she will immediately submit this completed form, including all corroborating documents of proof, to the Chief of Police, who will act upon it accordingly. Assigned personnel will communicate with the complainant and/or their attorney to arrange for an interview regarding this investigation at a convenient date and time.

Complainants Information
Complainants Name*
Date of Birth*
MM slash DD slash YYYY
Email*
Phone*
Cell Phone
Work Phone
Primary Language (if not English)*
Representative/Interpreter
Phone
Details of Incident
Name of Officer/Employee*
Location of Incident*
Date of Incident*
MM slash DD slash YYYY
Time of Incident*

: Hours

Minutes

AM/PM
Does Complainant give permission to be contacted at work?*
- Yes
- No
Other Documentation*
- Photographs
- Physical Evidence
- Other
If other documentation, please describe
Final Disposition*
Date of Purge
MM slash DD slash YYYY
Details of Complaint (to be completed by Complainant)*
Consent*
I hereby swear to affirm that all the material provided in this form are true and correct to the best of my knowledge, information and belief.

Complainants Information

Details of Incident