Form Ex-070 - Public Complaint Against Employee

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EX-070 (08/2011)
MICHIGAN STATE POLICE
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PUBLIC COMPLAINT AGAINST EMPLOYEE
AUTHORITY: 1935 PA 59, as amended; COMPLIANCE: Voluntary
This form is for use by members of the public who wish to make a complaint concerning an employee of the
Michigan State Police. This form should be filled out as completely as possible and submitted to the Professional
Standards Section. An investigator will contact you after the form has been received by the Professional Standards
Section. An investigation will be conducted if appropriate.
Questions should be directed to the Professional Standards Section during business hours at (517) 241-0204.
Submit the completed form using one of the methods below.
U.S. Mail:
Fax: (517) 241-0218
E-Mail:
MSPIA@michigan.gov
Michigan State Police
Professional Standards Section
P.O. Box 30634
333 S. Grand Ave.
Lansing, MI 48909-0634
I. About You
Title
Name (First, Middle Initial, Last)
Ms.
Mrs.
Mr.
Other:
Street Address
City
State
ZIP Code
Home Phone
Work Phone
Cell Phone
E-Mail
(
)
(
)
(
)
Preferred Method of Contact
Home Phone
Cell Phone
Work Phone
Preferred Hours:
Have you reported this incident to anyone else within the Michigan State Police?
Yes
No
If yes, to whom and on what date:
II. About Known Witnesses
Tell us about others who may have witnessed or taken part in the incident. If extra space is needed, list the additional witnesses
or information in Section V.
Name
Address and Phone Number
Name
Address and Phone Number
Name
Address and Phone Number
III. About Our Employees
List all Michigan State Police employees you are complaining about, and include rank and full name if known. If extra space is
needed, list the additional employees or information in Section V.
Employee 1
Post or Work Location
Employee 2
Post or Work Location
Employee 3
Post or Work Location
IV. About the Incident
Be as specific as possible and provide all requested information.
Date
Time
Location
Related Police Report Number
Michigan State Police License Plate Number
N/A or Unknown
N/A or Unknown

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