Correctional Facility Complaint Form
Submit your complaint or concern regarding a correctional facility. Your information will help us address the issue promptly and appropriately.
Are you submitting this complaint anonymously?
*
Yes, I want to remain anonymous
No, I will provide my contact information
Your Full Name
First Name
Last Name
Your Email Address
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you currently an inmate at the facility?
*
Yes
No
Facility Name
*
Facility Location (City/State)
*
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Complaint
*
Please Select
Staff Misconduct
Inmate-on-Inmate Issue
Facility Conditions
Medical or Health Concern
Safety or Security Issue
Other
Describe the issue or incident in detail
*
Who was involved? (Names or roles, if known)
Is this complaint urgent?
*
Yes
No
Attach any supporting documents or evidence (optional)
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