Grant County Sheriff's Office
Complaint Against Employee
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Language
*
CAD Incident #
Complaint Type
Informal
Formal
Incomplete
Date of Complaint
*
Time of Complaint
*
Individual Filing the Complaint
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Complainant is a minor/needs help.
Yes
No
Information of individual completing the form on behalf of another:
First Name
*
Middle Name
Last Name
*
Address
*
City
*
State
Zip
Home Phone
Cell Phone
Email
Relationship to Complainant
I want to remain anonymous.
First Name
*
Middle Name
Last Name
*
Address
*
City
*
State
Zip
Home phone
Cell phone
*
Additional phone
Email
Additional Email
Date of Birth
Age
Race
Gender
*
Driver’s License #
Disability
Type of Disability(s)
Anxiety Disorder
Bi-Polar
Deaf
Depression
In Wheelchair
Missing Limbs
Mute
Other
Panic Disorder
Post-Traumatic Stress Disorder
Schizophrenia
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
No
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 #
Email
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
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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
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Date of Incident
Date of Incident
*
Day of Incident
Time of Incident
Incident Location
Address
City
State
Zip
Incident Description
*
Supporting Documentation
Photo
Video
Attachment(s) supporting complaint:
File Name
Created
No attachment available
View
Preview and Submit
Complaint Against Employee Preview
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Language
CAD Incident #
Complaint Type
Date of Complaint
Time of Complaint
Individual Filing the Complaint
Please enter Instruction here
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
Email
Relationship to Complainant
I want to remain anonymous.
First Name
Middle Name
Last Name
Address
City
State
Zip
Home phone
Cell phone
Additional phone
Email
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
Please enter Instruction here
Witness Information
First name
Middle name
Last name
Address
City
State
Zip
Home phone
Cell phone
Additional Phone #
Email
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
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
Please enter Instruction here
Date of 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 understand that this statement will be the basis for an investigation. The facts contained in my statement are true to the best of knowledge and belief. In addition, I declare and affirm that my statement has been made voluntarily and without persuasion, coercion, or promise of any kind.
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