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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Preferred Phone Number*
14. Phone Type

    1. Home
    2. Work
    3. Cell
15. Email Address*
19. Select one.*

    1. I am submitting a compliment/commendation.
    2. I am submitting a complaint.
21. Please indicate your preference.

    1. You have permission to publicize my name.
    2. I would like to remain anonymous.
23. Employee Name(s)*
    If the employee's name is unknown, please provide any known identifying information.
25. Occurrence Date/Time*
    Occurrence Date/Time

    Occurrence Date/Time
26. Occurrence Location*
28. Describe the occurrence giving rise to your complaint or compliment in as much detail as possible.*
32. Witness Information - FOR COMPLAINTS ONLY
    Please provide information about any witnesses to the events giving rise to your complaint.
34. WITNESS 1
36. First Name
37. Last Name
39. Address1
41. Address2
43. City
44. State
45. Zip
47. Phone Number
48. Phone Type

    1. Home
    2. Work
    3. Cell
49. Email Address
51. Do you have information to include for additional witnesses?

    For complaints only.

    1. Yes
    2. No
53. First Name
54. Last Name
56. Address1
58. Address2
60. City
61. State
62. Zip
64. Phone Number
65. Phone Type

    1. Home
    2. Work
    3. Cell
66. Email Address
68. Do you have information to include for an additional witness?

    1. Yes
    2. No
70. First Name
71. Last Name
73. Address1
75. Address2
77. City
78. State
79. Zip
81. Phone Number
82. Phone Type

    1. Home
    2. Work
    3. Cell
83. Email Address
85. To ensure public trust and confidence in the Department, every complaint will be thoroughly investigated. If any further information is needed to process a complaint, you and any witness(es) may be contacted by the Supervisor conducting the investigation. Following the conclusion of the investigation, you will be notified in person, by mail or by telephone by the Supervisor of the conclusion reached in the investigation of your complaint.
87. I certify that, to the best of my knowledge and belief, the information provided is a true statement.
Leave This Blank:


89. 1. Receive an email copy of this form.
90. Email address

    This field is not part of the form submission.

91. Submit

* indicates a required field