Citizen Complaint

Complaint Against Employee

As a citizen, you have the right to initiate a complaint if you feel that you have been treated improperly by a police officer. This department encourages legitimate complaints and will thoroughly investigate all complaints received. You will be advised of the outcome of the investigation in writing by the Chief of Police. In order to properly investigate your complaint, we ask you to put it in writing. This form may be used for that purpose. Feel free to attach any additional pages or information as needed.

You have the right to make a complaint against a police officer for any improper police conduct. California law requires this agency to have a procedure to investigate citizens’ complaints. You have a right to a written description of this procedure. This agency may find after investigation that there is not enough evidence to warrant action on your complaint; even if that is the case, you have the right to make the complaint and have it investigated if you believe an officer behaved improperly. Citizen complaints and any reports or findings related to complaints must be retained by this agency for at least five years. It is against the law to make a complaint that you know to be false. If you make a complaint against an officer knowing that it is false, you can be prosecuted on a misdemeanor charge.

Language*

CAD Incident #

Date of Complaint*

Time of Complaint*

Individual Filing the Complaint

Enter your personal information so we may contact you directly if our investigators have any additional questions and to notify you upon completion of our investigation.

You may remain anonymous by checking the appropriate checkbox if you wish, however, we will have no means to notify you of the outcome of the investigation. If you complete this form on behalf of another, please provide your information in addition to the individual's information on whose behalf you submitting this complaint.

Complainant is a minor/needs help.

Yes

Information of individual completing the form on behalf of another:

First Name

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Relationship to Complainant

I want to remain anonymous.

First Name

Last Name

Address

City

State

Zip

Home phone

Cell phone

Date of Birth

Race

Gender

Driver’s License #

Disability

Type of Disability(s)

Best time to contact?

Primary Language Spoken

Are you able to communicate in English?

Arrested?

Citation Number

Injury Information

Was complainant injured during the incident?

Yes

Type of Injury

Severity of Injury

Did you seek medical attention?

Doctor Information

Doctor’s Name

Doctor’s Phone

Attorney Information

Attorney's Name

Attorney's Phone

Witness Remove

Enter any individuals that have or may have witnessed the incident.

Witness Information

First name

Last name

Address

City

State

Zip

Home phone

Cell phone

Date of Birth

Race

Gender

Driver’s License #

Relationship to Complainant

Witness Relationship to Employee

There are no Employee declared yet.

Employee Name

Relationship to Employee

Witness

Employee Remove

Please enter any information of the employee(s) who you are complaining on. if you do not know the involved employee's name or ID number, please describe them as best as possible as this will assist the Department in identifying the employee.

Employee Information

Employee #

First name

Last name

Race

Gender

In Uniform

Description of Employee

Vehicle Information

Vehicle Number

Vehicle Characteristics

Employee

Incident

If this complaint Involves Rational or Identity Profiling Please indicate below all the profiling.

Race or Ethnicity
Nationality
Gender
Age
Religion
Gender Identity or Expression
Sexual Orientation
Mental Disability
Physical Disability

Date of Incident

Time of Incident

Incident Location

Address

City

State

Zip

Incident Description

Supporting Documentation

Attachment(s) supporting complaint:

File Name	Created
No attachment available
		View

Complaint Against Employee Preview

Language

CAD Incident #

Date of Complaint

Time of Complaint

Individual Filing the Complaint

Enter your personal information so we may contact you directly if our investigators have any additional questions and to notify you upon completion of our investigation.

Complainant is a minor/needs help.

Information of individual completing the form on behalf of another:

First Name

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Relationship to Complainant

I want to remain anonymous.

First Name

Last Name

Address

City

State

Zip

Home phone

Cell phone

Date of Birth

Race

Gender

Driver’s License #

Disability

Type of Disability(s)

Best time to contact?

Primary Language Spoken

Are you able to communicate in English?

Arrested?

Citation Number

Injury Information

Was complainant injured during the incident?

Type of Injury

Severity of Injury

Did you seek medical attention?

Doctor Information

Doctor’s Name

Doctor’s Phone

Attorney Information

Attorney's Name

Attorney's Phone

Witness

Enter any individuals that have or may have witnessed the incident.

Witness Information

First name

Last name

Address

City

State

Zip

Home phone

Cell phone

Date of Birth

Race

Gender

Driver’s License #

Relationship to Complainant

Witness Relationship to Employee

There are no Employee declared yet.

Employee Name

Relationship To Employee

Employee

Employee Information

Employee #

First name

Last name

Race

Gender

In Uniform

Description of Employee

Vehicle Information

Vehicle Number

Vehicle Characteristics

Incident

If this complaint Involves Rational or Identity Profiling Please indicate below all the profiling.

Race or Ethnicity
Nationality
Gender
Age
Religion
Gender Identity or Expression
Sexual Orientation
Mental Disability
Physical Disability

Date of Incident

Time of Incident

Incident Location

Address

City

State

Zip

Incident Description

Supporting Documentation

Attachment(s) supporting complaint:

File Name	Created
No attachment available

I confirm that I have read understood the "Electronic Record and Signature Disclosure" and consent to use electronic records and signatures.

Signature

Clear