Commendation and Complaint Form

Commendation and Complaint Form
Please complete all information as thoroughly and accurately as possible, providing as much detail as you can remember.
Type of Report

Commendation or ComplimentComplaintSuggestion or Inquiry
Contact Information
Name

Last NameFirst NameMiddle NameSuffix
Date of Birth

MonthDayYear
Address

Street Address

Street Address Line 2

CityState

Zip Code
Daytime Phone
Please enter a valid phone number.
Evening Phone
Please enter a valid phone number.
Information About the Incident
Date and Time of Incident

MonthDayYear
Hour MinutesAM/PM Option
Case Number (if Issue)
Location of Incident
Name of Witness
Phone Number
Please enter a valid phone number.
Name of Witness
Phone Number
Please enter a valid phone number.
Information About the JCSO Employee(s) Involved
Employee Name or Description
Employee Name or Description
Employee Name or Description
Disclaimer
While we encourage the reporting of legitimate complaints, if you knowingly make a false report to law enforcement authorities of a crime or other incident, you can be charged with a class A misdemeanor. Filing a complaint against a police employee will not lessen or otherwise affect the outcome of any criminal or civil case in which you may be involved.
Acknowledgment
I affirm the information provided in this statement is true and factual to the best of my knowledge. I understand it may be necessary for me to be interviewed or to provide other assistance during the investigation of a complaint.
Please Confirm

I understand and agree
Printed Name
Date

MonthDayYear
For Internal Use Only
PSU #
Date Report Received

MonthDayYear
Please verify that you are human*
Should be Empty:

Commendation and Complaint Form

Contact Information

Information About the Incident

Information About the JCSO Employee(s) Involved

Acknowledgment

For Internal Use Only