Page Police Department | Complaint of Employee Misconduct

* Required field

Complaint of Employee Misconduct Form

This form should be used exclusively to report employee misconduct. Complaints regarding Page Police Department policies and procedures, or police response time to a location, should be discussed with the shift supervisor at the police station. Upon completion of this form, you may fax it to (928) 645-4369 and return it in person to the police station, or mail a copy to PAGE POLICE DEPARTMENT Internal Affairs Division, P.O. Box 3005, Page, AZ 86040. Keep a copy for your records.

Name *

Phone *

Event *

Day

Evening

Address *

Language Spoken *

Date of Occurrence *

Time of Occurrence *

Location of Occurrence *

Names, Badge Numbers of Serial Numbers of Employees Involved (If known)

Names, addresses, and telephone numbers of witnesses present at the time of occurrence (If known)

Name of Employee #1

Witness Present #1

Name of Employee #2

Witness Present #2

Name of Employee #3

Witness Present #3

(LIST ADDITIONAL EMPLOYEES AND/OR WITNESSES UNDER THE "DETAILS" SECTION.)

Please state your complaint, including names, times, locations, witnesses, and any other information that would help in investigating your complaint. If employee names are unknown, explain what each employee looked like.

Details *

The responsibility of a complainant. The Page Police Department views all allegations of impropriety against its police personnel seriously and actively conducts an investigation on employee misconduct. For this reasons, the complainant must ensure that their complaint is based on fact. False reporting in an attempt to unjustly discipline or defame police personnel or to place their employment in jeopardy can result in criminal charges or civil suit by the employee involved.

DEPARTMENT USE ONLY

To be completed by the supervisor receiving this form.

Supervisor's name

Serial Number

Date and time received

Division

Final disposition

(i.e. forwarded to IAD; 1.81 initiated; sent correspondence to complainant, etc.)

(Attach additional sheets, if necessary.)

IAD NO.

DIV. NO.

Please confirm your signature by typing your full name in the box below.

I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature.