2. Procedure: In order to effectively deal with complaints against Police Personnel, the following
   information is requested. This information will be used to assist in the investigation of the complaint. Please review the informational brochure or go on-line for
   more information about the process or ask to speak with a police department supervisor. Upon
   receipt of your complaint you will be asked to meet with a supervisor for follow-up information. The
   meeting may be held at the police department or other appropriate location upon your request.
6. Name of the Officer*
8. Name of Person Making Complaint*
9. Telephone*
11. Address*
12. Email Address*
16. Name(s) of Person(s) Involved In Incident
18. Name*
19. Telephone*
21. Address*
23. Name
24. Telephone
26. Address
30. Nature of Complaint*
32. Day, date, and time of incident*
34. Location where incident occurred*
36. Witness to event or incident (names, addresses, and telephone numbers)
38. Detailed report of complaint*

42. I do hereby certify that the above report is true, accurate, and complete as best I can present the facts pertinent to this complaint.

     I understand that I may be requested to provide additional information and may be summoned to appear as a witness concerning the facts that I have outlined, if the complaint results in a disciplinary hearing held by the Anderson Board of Public Safety. 

    I understand that the investigation will follow the procedures set forth in the informational brochure that has been made available to me in paper format or on-line. I understand I will be required to cooperate in the investigation as outlined in the brochure to the best of my ability. 

    Once submitted, this form will be received by the appropriate supervisor. You should expect to be contacted within two business days. If for some reason you have not been contacted within that time frame or you have additional questions you can call the Police Department Administrative Staff at 765-648-6715.

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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field