Civilian Complaint Form
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3CIVILIAN COMPLAINT FORM
ALL INFORMATION CONTAINED IN THIS REPORT WILL BE KEPT STRICTLY
CONFIDENTIAL AND WILL BE SUBMITTED DIRECTLY TO THE DIRECTOR OF
PUBLIC SAFETY.
INSTRUCTIONS
1. If you prefer your complaint to be filed anonymously, do not answer questions
1 through 6 a.
2. If you wish to be informed of the disposition of your complaint by the Director of
Public Safety, fill the report out completely (include business and residence
telephone phone numbers).
3. Item #7:
Indicate the date and time you are making your Civilian Complaint.
4. Item #8:
Indicate the day, date and time that the occurrence you are filling this
complaint about took place.
5. Item #9:
Give the best description of the Roosevelt Island Public Safety Dept.
member(s) involved and their name and shield numbers, if known.
6. Item #10: Give as complete an explanation as possible of what transpired, and
the basis for your complaint.
7. Seal your Civilian Complaint Report in an envelope and return to the Roosevelt Island
Public Safety office.
If you prefer to file this report anonymously, check the box to the left.
(DO NOT ANSWER QUESTIONS 1 to 6a below.)
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Parent category: Legal