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Complaint Against Employee

Complaints can be submitted by anyone whether directly or indirectly involved. You may remain anonymous, however, providing your information will assist our investigation into the matter. Information on the form is releasable as required by law. All complaints will be reviewed and investigated by a supervisor and complainants will be notified at the conclusion of the investigation.

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.
Injury Information
Doctor Information
Attorney Information

Witness Remove

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

Witness Information
Witness Relationship to Employee
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
Vehicle Information

Employee

Incident

Complaints can be submitted by anyone whether directly or indirectly involved. You may remain anonymous, however, providing your information will assist our investigation into the matter. Information on the form is releasable as required by law. All complaints will be reviewed and investigated by a supervisor and complainants will be notified at the conclusion of the investigation.



Date of Incident
Incident Location
Attachment(s) supporting complaint:
File Name Created
No attachment available
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Complaint Against Employee Preview

Complaints can be submitted by anyone whether directly or indirectly involved. You may remain anonymous, however, providing your information will assist our investigation into the matter. Information on the form is releasable as required by law. All complaints will be reviewed and investigated by a supervisor and complainants will be notified at the conclusion of the investigation.



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.


Injury Information
Doctor Information
Attorney Information

Witness

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

Witness Information
Witness Relationship to Employee
Employee Name
Relationship To Employee

Employee

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
Vehicle Information

Incident

Complaints can be submitted by anyone whether directly or indirectly involved. You may remain anonymous, however, providing your information will assist our investigation into the matter. Information on the form is releasable as required by law. All complaints will be reviewed and investigated by a supervisor and complainants will be notified at the conclusion of the investigation.



Date of Incident
Incident Location
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.

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