Form 52.1.5 - Citizen Complaint Form Page 2
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2FOR DEPARTMENTAL USE ONLY
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Supervisor’s decision on method to process the complaint:
Citizen Complaint Resoultion Process (CCRP)
Internal Affairs Investigation Process (IAIP)
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Complaint received via
Walk-in
Telephone
Mail
E-mail
Is there an original report number that this case refers to? ___________________________________________________
Were other Officers Involved?
Name _____________________________________________
Name _____________________________________________
Observations of Complainant
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Obvious Injury Noted
Yes
No (If yes, explain in detail the location and type of injury.)
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Complainant Intoxicated
Yes
No (If yes, explain)
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Does the complainant exhibit any unusual behavior
Yes
No (If yes, explain)
Notes:
Attachments
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Photos Attached
Yes
No (If yes, describe)
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Taped Statements Attached
Yes
No (If yes, describe)
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Medical Released Attached
Yes
No (If yes, describe)
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MDT Printout Attached
Yes
No (If yes, describe)
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Telephone Complaints
Yes
No (If yes, attach tape of telephone conversation) Line Number Utilized ____________ Date ___________ Time _______
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Mail or E-mail Complaints
Yes
No (If yes, attach copies of documents)
Chief of Police Use Only
Supervisor Assigned to Investigate the Complaint ________________________________________________________
Chief of Police Signature _____________________________________________________________________________ Date _______________
Form 52.1.5 Citizen Complaint Form Page 2
CONFIDENTIAL DOCUMENT
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