Egg Harbor Township Police Department

Internal Affairs Complaint Form

*Please take your time and fill in as much information as possible. This should expedite the process of the investigation and ensure its accuracy. This form should be used exclusively to report employee misconduct. Complaints regarding Egg Harbor Township Police Department policies and procedures, or Police response time to a location, should be discussed with the Supervisor or Officer In Charge at the Police station.

COMPLAINANT INFORMATION

NAME: ALIAS:

STREET ADDRESS:

CITY: STATE: ZIP: PHONE NO.

DOB: SS NO. AGE: SEX : Male Female

RACE: HISPANIC : YES NO

EMPLOYER/SCHOOL: PHONE NO.

ADDRESS:

CITY: STATE: ZIP:

INCIDENT INFORMATION

NATURE OF COMPLAINT:

COMPLAINT AGAINST-NAME(S) DISPATCH NO.

DATE: TIME: DATE/TIME REPORTED: HOW REPORTED:

INCIDENT LOCATION

DESCRIPTION OF OFFENSE/INCIDENT:

DESCRIPTION OF INJURIES:

PLACE OF TREATMENT:

DOCTORS NAME: DATE OF TREATMENT: