INVOLVED OFFICER/EMPLOYEE(S) INFORMATION: * 2ND INVOLVED OFFICER/EMPLOYEE(S) INFORMATION: PERSON MAKING THE COMPLAINTS NAME: * PERSON MAKING THE COMPLAINTS ADDRESS: PERSON MAKING THE COMPLAINTS PHONE NUMBER: * DATE OF CONTACT: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 APPROXIMATE TIME: Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm LOCATION: REASON FOR THE COMPLAINT: * WITNESS #1 Full name and Phone Number WITNESS #2 Full name and Phone Number WITNESS #3 Full name and Phone Number SUBMITTED BY: * SUBMITTED DATE: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 EMAIL ADDRESS * Leave this field blank
