Division______________________________________________________________IAD#_________________________________________________________________
INTERNAL AFFAIRS REPORT FORM | ||
Person Making Report (Optional, But Helpful) | ||
Full Name
Address
City, State
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_______________________________________________________
_______________________________________________________
_______________________________________________________
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Preferred? Phone _______________________________________________________ □
Email _______________________________________________________ □
DOB ______________________________________________________________
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Officer(s) Subject to Allegation (Provide Whatever Info Is Known) | ||
Officer(s)
Incident Site
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_______________________________________________________
_______________________________________________________
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Badge No. ____________________________________________________
Date/Time ____________________________________________________
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In the space below, describe the type of incident (traffic stop, street encounter) and any information about the alleged conduct. If you cannot fit your response below, feel free to use extra pages and attach them to this document. If you do not know the officer’s name or badge number, provide any other identifying information.
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Other Information | ||
How was this reported? □ In Person □ Phone □ Letter □ Email □ Other __________________________
Any physical evidence submitted? □ Yes □ No If yes, describe: __________________________________________
Was incident previously reported? □ Yes □ No If yes, describe: __________________________________________
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To Be Completed by Officers Receiving Report | ||
_______________________________________________________________________________________________________ _________________________ _______________________ Officer Receiving Complaint Badge No. Date/Time
_______________________________________________________________________________________________________ _________________________ _______________________ Supervisor Reviewing Complaint Badge No. Date/Time
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