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Civilian Complaint Report
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This form has been modified since it was saved. Please review all fields before submitting.
Reporting Person
Last Name
*
First Name
*
Middle Name
Phone Number
*
Residence Address
*
City
*
State
*
Zip Code
*
Business Address
Date of Birth
Persons Involved (if other than above)
Last Name
First Name
Middle Name
Date of Birth
Residence Address
Business Address
Day of Incident
Date of Incident
Location of Incident
*
Time of Incident
Witnesses
Name
Address
Phone
Name
Address
Phone
If witnesses are not known, give their description.
Name or Description of Employee(s) Involved
Name
Badge or ID Number
Physical Description
Name
Badge or ID Number
Physical Description
Name
Badge or ID Number
Physical Description
Persons Arrested
Name
Address
Phone Number
Name
Address
Phone Number
Briefly describe details of complaint:
Racial or Identity Profiling PC 13519.4(e)
Do you believe you were stopped, arrested, searched, or detained by law enforcement based, at least in part, on your race or ethnicity (including color), nationality/national origin, gender, age, religion, gender expression, sexual orientation, mental disability, or physical disability?
-- Select One --
Yes
No
Please explain or describe in detail why you believe you were stopped, arrested, searched, or detained based on your race or ethnicity (including color), nationality/national origin, gender, age, religion, gender expression, sexual orientation, mental disability, or physical disability:
*
If you are alleging racial or identity profiling, please select from the following:
-- Select One --
Race or Ethnicity
Nationality
Gender
Age
Religion
Sexual Orientation
Mental Disability
Physical Disability
Gender Identity or Expression
Penal Code Section 832.5 Civilian Complaints Against Department Personnel
You have the right to make a complaint against a police officer for any improper police conduct. California Law requires this agency to have a procedure to investigate civilian's complaints. You have the right to a written description of this procedure. This agency may find after investigation that there is not enough evidence to warrant action on your complaint. Even if that is the case, you have the right to make the complaint and have it investigated if you believe an officer behaved improperly. Civilian complaints and any reports or findings relating to complaints must be retained by the agency for at least five years.
I have read and understand the above statement.
*
I Acknowledge
A word of caution is offered concerning persons knowingly making false complaints about peace officers. Civil Code 47.5 (View note below) allows peace officers to bring civil action against a person filing a false complaint.
Note: Section 47.5 Civil Code can be found on the California Law Website Section 47.5 Civil Code (Peace Officers; defamation action against person filing false complaint alleging misconduct, criminal conduct, or incompetence)... a peace officer may bring an action for defamation against an individual who has filed a complaint with that officer's employing agency alleging misconduct, criminal conduct, or incompetence, if that complaint is false, the complaint was made with knowledge that it was false and that it was made with spite, hatred, or ill will.
I have read and understand the above statement.
*
I Acknowledge
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