Date
Date
Reporting Officer *
Reporting Officer
Type of Complaint
Check all that apply
If Possible: Include Address, Date of Birth, Driver’s license, and Phone Number Please Include Person(s) Status Description: C=Client M=Motorist E=Employee P=Pedestrian W=Witness
(Personal Knowledge, Verbal I.D., Driver’s License, Photo I.D, etc.)
(Client’s Property, Street Address or Intersection)
Date of Occurrence
Date of Occurrence
Approximate Time of Incident
Approximate Time of Incident
Date of notification
Date of notification
Time of Notification
Time of Notification
Was the person making the report interviewed?
Include all that are applicable from the following list: Race, Sex, Age, Height, Weight, Hair Color, Eye Color, Complexion, Facial Hair, Clothing and any other Distinguishing Characteristics
(Observed on Duty, Informed by others, etc)
Be as specific as possible, include all pertinent facts, dates, and times
Include Name, Address and Phone Number
Include Brand, Color and Model where applicable
Were the Police called?
Include Unit Number(s)
Was the Individual Arrested?