Citizen Complaint

Complaint Against Employee

• The Nixa Police Department takes seriously all complaints regarding the service provided by the Department and the conduct of its members.

• The Department will accept and address all complaints of misconduct in accordance with department policy and all applicable federal, state and local law and rules.

• It is also the policy of this department to ensure that the community can report misconduct without concern for reprisal or retaliation.

• This form is for complaints against police employees, if you have a complaint about a criminal matter, please file a police report.

The following things should be kept in mind when you are considering filing a complaint:

• If you have a ticket or criminal charge pending in any Court, filing a complaint will not result in the ticket or charge being dismissed. The complaint process has no bearing on the court system. The matter must be resolved in the appropriate Court.

• Filing a complaint will not subject you to additional police action, or any type of “harassment.”

• Filing a complaint will not prevent police from conducting legitimate law enforcement related activities involving you, or the area in which you live, work, frequent, or in the location in which the incident complained of occurred.

• Under Missouri law, it is unlawful to make a false report to the police, hinder or interfere with an investigation, or provide false information to the police.

Language*

CAD Incident #

Type of Complaint

Date of Complaint*

Time of Complaint*

Individual Filing the Complaint

Complainant is a minor/needs help.

Yes

Information of individual completing the form on behalf of another:

First Name

Middle Name

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Relationship to Complainant

I want to remain anonymous.

First Name

Middle Name

Last Name

Address

City

State

Zip

Home phone

Cell phone

Additional phone

Additional Email

Date of Birth

Age

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

Witness Information

First name

Middle name

Last name

Address

City

State

Zip

Home phone

Cell phone

Additional Phone #

Additional Email

Date of Birth

Age

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

Employee Information

Employee #

First name

Middle name

Last name

Age

Race

Gender

In Uniform

Division

Unit

Description of Employee

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Number

Vehicle Characteristics

Employee

Incident

Date of Incident

Day 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
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Complaint Against Employee Preview

• The Nixa Police Department takes seriously all complaints regarding the service provided by the Department and the conduct of its members.

• The Department will accept and address all complaints of misconduct in accordance with department policy and all applicable federal, state and local law and rules.

• It is also the policy of this department to ensure that the community can report misconduct without concern for reprisal or retaliation.

• This form is for complaints against police employees, if you have a complaint about a criminal matter, please file a police report.

The following things should be kept in mind when you are considering filing a complaint:

• Filing a complaint will not subject you to additional police action, or any type of “harassment.”

• Under Missouri law, it is unlawful to make a false report to the police, hinder or interfere with an investigation, or provide false information to the police.

Language

CAD Incident #

Type of Complaint

Date of Complaint

Time of Complaint

Individual Filing the Complaint

Complainant is a minor/needs help.

Information of individual completing the form on behalf of another:

First Name

Middle Name

Last Name

Address

City

State

Zip

Home Phone

Cell Phone

Relationship to Complainant

I want to remain anonymous.

First Name

Middle Name

Last Name

Address

City

State

Zip

Home phone

Cell phone

Additional phone

Additional Email

Date of Birth

Age

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

Witness Information

First name

Middle name

Last name

Address

City

State

Zip

Home phone

Cell phone

Additional Phone #

Additional Email

Date of Birth

Age

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

Middle name

Last name

Age

Race

Gender

In Uniform

Division

Unit

Description of Employee

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Number

Vehicle Characteristics

Incident

Date of Incident

Day 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

By signing my name below, I hereby certify that the statements given by me herein are true and accurate to the best of my personal knowledge. I understand that making intentional false declarations to public servants or untrue statements under oath or affirmation may be punishable by law.

Signature

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