Compliment/Complaint Form

Utica Police Department

Compliment - Complaint Form

413 Oriskany Street

Utica, N.Y. 13502

Instructions: If you would like to praise a Utica Police Department employee, or file a complaint against a police employee, please write legibly and fill out this form. Personal information will not be disclosed to the public, unless required by law. You can submit this form by mailing it to the address given at the top of this page or by returning it to the Utica Police Department.

If you are filing a complaint, please indicate the type of complaint you wish to file.

- Formal Complaint: Involves a serious allegation of misconduct, to be officially investigated, for which discipline may be imposed, if the allegation(s) are sustained.

- Informal Complaint: Involves a minor complaint or concern, for informational purposes only and will not be formally investigated. However the matter will be discussed with the employee(s) involved.

I wish to file a (select one)*

ComplimentFormal ComplaintInformal Complaint

Information about you

First NameLast Name

Sex

MaleFemale

Age

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number

Area CodePhone Number

Work or Mobile Phone Number

Area CodePhone Number

Are you filing this on behalf of someone else? If Yes, please complete this section*

YESNO

Information about them

First NameLast Name

Sex

MaleFemale

Age

Their Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

WHAT IS HIS or HER RELATIONSHIP TO YOU?

Home Phone Number

Area CodePhone Number

Work or Mobile Phone Number

Area CodePhone Number

Information about the incident

Location or Address of Incident*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date*

MonthDayYear

Time of Incident*

:HourMinutesAM/PM Option

Witness Name

First NameLast Name

Witness Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Sex

MaleFemale

Age

Name or ID# of Officer or Employee*

Name or ID# of Second Officer or Employee, IF KNOWN

Nature of Action: Check all that apply*

	Yes	No
Extremely Helpful
Very Caring/empathetic
Did a great job
Made an extra effort
Excessive and improper use of force
False arrest
Unlawful search and/or seizure
Dishonesty and untruthfulness
Corruption
Rudeness, discourtesy, and offensive language
Violation of civil rights
Bias-based procedures and tactics
Other

Statement of Facts: (Describe in detail the action(s) of the officer(s) that led you to file this compliment/complaint and sign and date below in the space provided.)

False or incorrect statements made herein are punishable as a class A misdemeanor pursuant to section 210.45 of the New York State Penal Law.