Police Misconduct Accusation Form

Full Name

First NameMiddle NameLast Name

Preferred Contact Method

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Date of Incident

Date

Approximate Time of Incident

Hour Minutes

AM/PM Option

Location of Incident

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Police Department or Agency Involved

Badge Number (if known)

Number of Officers Involved

Brief Description of What Happened

Incident Status

Type of Misconduct Alleged

Describe Injuries, Damage, or Other Consequences

Evidence Available

Additional Details About the Alleged Misconduct

Witnesses

Description of Evidence Available

Upload Photos, Videos, Audio, Documents, or Screenshots

If files cannot be uploaded, describe where the evidence can be reviewed

Acknowledgement and permission to review this complaint

Signature