Citizen Compliment

Compliment/Commendation Information

Pursuant to Section 76-8-504.5 Utah Code annotated, 1953 as amended, you are notified that statements you are about to make may be presented to a magistrate or judge in lieu of your sworn testimony as a preliminary examination. Any false statements you make and that you do not believe to be true may be subject to criminal punishment as a Class A Misdemeanor.

Language*

CAD Incident #

Date of Compliment*

Time of Compliment*

Individual Making the Compliment

Please tell us a little bit about yourself or the person on whose behalf you are completing this form:

Person 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 citizen?

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

Disability

Type of Disability(s)

Best time to contact?

Primary Language Spoken

Are you able to communicate in English?

Witness Remove

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

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 citizen?

Witness Relationship to Employee

There are no Employee declared yet.

Employee Name

Relationship to Employee

Witness

Employee Remove

Please provide as much information as possible about the employee with who's service you have been happy with.

Employee Information

Employee #

First name

Middle name

Last name

Age

Race

Gender

In Uniform

Division

Section

Unit

Description of Employee

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Number

Vehicle Characteristics

Employee

Incident

Please give a description of the compliment you would like to report. The more detailed your description the better.

Date of Incident

Day of Incident

Time of Incident

Location of Incident

Address

City

State

Zip

Incident Description

Supporting Documentation

Compliment/Commendation Preview

Language

CAD Incident #

Date of Compliment

Time of Compliment

Individual Making the Compliment

Please tell us a little bit about yourself or the person on whose behalf you are completing this form:

Person 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 citizen?

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

Disability

Type of Disability(s)

Best time to contact?

Primary Language Spoken

Are you able to communicate in English?

Witness

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

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 citizen?

Witness Relationship to Employee

There are no Employee declared yet.

Employee Name

Relationship To Employee

Employee

Please provide as much information as possible about the employee with who's service you have been happy with.

Employee Information

Employee #

First name

Middle name

Last name

Age

Race

Gender

In Uniform

Division

Section

Unit

Description of Employee

Vehicle Information

Vehicle Make

Vehicle Model

Vehicle Color

Vehicle Number

Vehicle Characteristics

Incident

Please give a description of the compliment you would like to report. The more detailed your description the better.

Date of Incident

Day of Incident

Time of Incident

Location of Incident

Address

City

State

Zip

Incident Description

Supporting Documentation

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

Signature

Clear