IA Case Number
Officer(s) Subject to Allegation (Provide Whatever Info Is Known)
Drag and Drop (or)
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.
How was this reported?
Any physical evidence submitted?
If Yes, Please select
Was incident previously reported?
To Be Completed by Officers Receiving Report
Officer Receiving Complaint
Supervisor Reviewing Complaint