Citizen Complaint

Complaint Against Employee

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Language*

CAD Incident #

Type of Complaint

Date of Complaint*

Time of Complaint*

Individual Filing the Complaint

Questions, comments? Call the Professional Standards Unit 817-222-7143

“Integrity – Compassion – Excellence - Vigilance”

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

Date of Birth

Age

Race

Gender

Best time to contact?

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

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Witness Information

First name

Middle name

Last name

Address

City

State

Zip

Home phone

Cell phone

Additional Phone #

Date of Birth

Age

Race

Gender

Relationship to Complainant

Witness Relationship to Employee

There are no Employee declared yet.

Employee Name

Relationship to Employee

Witness

Employee Remove

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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

Clearly and chronologically state what happened, ensuring that you articulate the conduct, facts and evidence in support ofyour allegation(s). Please sign all pages that bear your statement and initial all corrections. Please include any available witness information including addresses and phone numbers.

By submitting this complaint, I acknowledge that I have read each page of this statement consisting of the above pages. I certify the facts contained herein are true and correct.

Filing a false complaint against a police employee is a violation of the Texas Penal Code, Section 37.02. If a person knowingly and intentionally makes a false statement under oath, or swears to the truth of a false statement previously made under oath, a person may be found guilty and punished by a fine up to $4,000, confinement in jail up to one year, or by both fine and imprisonment.

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

Please enter Instruction here

Language

CAD Incident #

Type of Complaint

Date of Complaint

Time of Complaint

Individual Filing the Complaint

Questions, comments? Call the Professional Standards Unit 817-222-7143

“Integrity – Compassion – Excellence - Vigilance”

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

Date of Birth

Age

Race

Gender

Best time to contact?

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

Please enter Instruction here

Witness Information

First name

Middle name

Last name

Address

City

State

Zip

Home phone

Cell phone

Additional Phone #

Date of Birth

Age

Race

Gender

Relationship to Complainant

Witness Relationship to Employee

There are no Employee declared yet.

Employee Name

Relationship To Employee

Employee

Please enter Instruction here

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

By submitting this complaint, I acknowledge that I have read each page of this statement consisting of the above pages. I certify the facts contained herein are true and correct.

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