Los Angeles Police Department Complaint Form:

LOS ANGELES POLICE DEPARTMENT

COMPLAINT OF EMPLOYEE MISCONDUCT

This form should be used exclusively to report employee misconduct. Complaints regarding Los Angeles Police Department policies and procedures, or police response time to a location, should be discussed with the watch commander at your local police station. Upon completion of this form, you may either return it in person to the nearest police station, or mail the top copy to LOS ANGELES POLICE DEPARTMENT, Internal Affairs Division, P.O. Box 30158, Los Angeles, CA 90099-4896. A preaddressed business reply envelope has been provided for you convenience. Keep the second copy for your records.
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Name____________________________________ Phone_______________________

Address__________________________________ Language Spoken___________________________

Date of Occurrence_________________________ Time of Occurrence__________________________

Location of Occurrence__________________________________________________________________

Names, Badge Numbers or Serial Numbers of Employees Involved (If known)

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Names, addresses, and telephone numbers of witnesses present at the time of occurrence. (If known)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

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(LIST ADDITIONAL EMPLOYEES AND/OR WITNESSES UNDER THE “DETAILS” SECTION.) Details – (Please state your complaint, including names, times, locations, witnesses, and any other information that would help in investigating your complaint. If employee names are unknown, explain what each employee looked like.)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

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Date________________________________ Signature_____________________________

DEPARTMENTAL USE ONLY

To be completed by the supervisor receiving this form.

Supervisor’s name __________________________ Serial Number _____________________________

Date and time received _______________________ Division __________________________________

Final disposition ____________________________________________________________________________________________

(i.e. forwarded to IAD; 1.81 initiated; sent correspondence to complainant, etc.)
(Attach additional sheets, if necessary.)

IAD NO._______________

DIV. NO. _______________

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