Intake Form: Test

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Intake Form: Commendation or Complaint

Page 1: “Introduction / Basic Information"

I am filing a: *

Complaint
Commendation

I Was:

Helped
Protected
Profiled
Neglected
Physically Harmed
Other

Page 2: “Your Information"

I Am:

Name *

First

Last

Full Name: (If you wish to be anonymous, please type "Anonymous" in the name field.)

Please note that by filing a complaint anonymously you will not be able to be interviewed by investigators if your complaint is accepted for investigation.

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DOB:

Race:

Gender:

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Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Please Check One:

Yes, I feel comfortable with you providing my information to NOPD so they can conduct a misconduct investigation or include my information in the commendation.
No, I do not want my information released to NOPD

If no, check what information you do not want to provide to NOPD:

Name
DOB
Race
Gender
Phone Number
E-mail
Address

Page 3: “Incident Details"

Date of Incident

Time of Incident

Location of Incident

Please Describe The Interaction Of The Officer(s)

• If this was a commendation, please describe why this interaction was helpful or positive.
• If this is a complaint, please describe why this interaction was problematic or negative.

Details Of The Interaction:

Page 4: “Officer Information"

I Know This Information About The Officer(s)

Name(s):

Badge Number(s):

Unit or District Information

Supervisor(s):

Description Of The Officer:

Please include information like: gender, race, approximate age, size, glasses, tattoos, and anything else that would help identify the officer(s)

Page 5: “Witness Information"

The Following People Were Around / Witnessed This Interaction

(This is more important for complaints)

Name(s):

Witness Phone Number

Witness Email

Witness Other Contact Information:

How Do You Know This Person(s):

Page 6: “Upload Documents"

I Have This Information Regarding The Interaction

(Select All that Apply)

Media

Video
Photos
Facebook/Social Media Content
Police Report
Other