Complaint Against Employee

Tiverton Police Department

Complaint Form

20 Industrial Way Tiverton, Rhode Island 02878

(401) 625-6717

www.tivertonpoliceri.com

The Tiverton Police Department is dedicated to providing the highest quality police services to residents of, and visitors to, Tiverton. Your complaints are important to the department and we appreciate you taking the time to communicate with us.

If you would like to file a complaint against an employee of the Tiverton Police Department, please fill out and submit this form. Personal information will not be disclosed to the public unless required by law.

CAD Incident #

Type of Complaint

Date of Complaint*

Time of Complaint*

Individual Filing the Complaint

Are you filing this on behalf of someone else?

If Yes, then complete this section

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

Last Name

Address

City

State

Zip

Home phone

Cell phone

Age

Gender

Did you seek medical attention?

Doctor Information

Doctor’s Name

Doctor’s Phone

Witness Remove

Witness Information

First name

Last name

Address

City

State

Zip

Home phone

Age

Gender

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

Description of Employee

Employee

Incident

Information about the 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
		View

Complaint Against Employee Preview

Tiverton Police Department

Complaint Form

20 Industrial Way Tiverton, Rhode Island 02878

(401) 625-6717

www.tivertonpoliceri.com

CAD Incident #

Type of Complaint

Date of Complaint

Time of Complaint

Individual Filing the Complaint

Are you filing this on behalf of someone else?

If Yes, then complete this section

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

Last Name

Address

City

State

Zip

Home phone

Cell phone

Age

Gender

Did you seek medical attention?

Doctor Information

Doctor’s Name

Doctor’s Phone

Witness

Witness Information

First name

Last name

Address

City

State

Zip

Home phone

Age

Gender

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

Description of Employee

Incident

Information about the 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

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

Signature

Clear