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POLICE INTERNAL AFFAIRS

POLICE COMPLAINT FORM

    TEST MODE TEST MODE TEST MODE
    NOT ACTIVE CURRENTLY
    Department/Agency _________________________________ IA Case Number _________________________________

    INTERNAL AFFAIRS REPORT FORM

    Person Making Report (Optional, But Helpful)






    Preferred Method of Contact
    PHONEEMAIL
    ----------------------------------------
    Officer(s) Subject to Allegation (Provide Whatever Info Is Known) ----------------------------------------

    Other Information
    How was this reported? In-PersonBy PhoneBy LetterBy EmailOther Any Physical Evidence Submitted? YesNo Was incident previously reported? YesNo ----------------------------------------
    To Be Completed by Officers Receiving Report
    Officer Receiving Complaint _________________________________ Badge No. ________ Supervisor Reviewing Complaint ______________________________ Badge No. ________