Step
1
of
4
25%
Legal Advisement and Acknowledgment
(Required)
You have the right to make a complaint against a police officer for any improper police conduct. Utah law requires this agency to have a procedure to investigate citizens' complaints. You have a right to a written description of this procedure. This agency may find after investigation that there is not enough evidence to warrant action on your complaint; even if that is the case, you have the right to make the complaint and have it investigated if you believe an officer behaves improperly.
I have read and understand the above statement.
Additional Note:
(Required)
• If this is an emergency call 911
• If police action or investigation is necessary for the item you are commenting on, please contact dispatch so that an officer can assist you properly and in a timely manner
I have read and understand the above statements and instructions.
Reporting Person's Information
Today's Date
(Required)
Sex
Male
Female
DOB (MM/DD/YYYY)
Reporting Person's Name
First Name
Middle
Last Name
Residence Address
Street Address
Address Line 2
City
State / Province / Region
Phone
Email
(Required)
Victim's Information
Victim same as above?
Yes
No
Victim's Name
First
Middle
Last
Victim DOB (MM/DD/YYYY)
Victim Age
Victim Sex
Male
Female
Victim Arrested?
No
Yes
Victim Address
Street Address
Address Line 2
City
State / Province / Region
Attorney or Representative
Attorney or Representative Phone
Employees & Others Involved
Name of West Jordan Employee(s) if Known
First & Last if known
Rank, Badge, Car No. if Known
Description of Employee(s)
Name of Witness(es)
(First, Middle, Last)
Witness Phone
Witness Address
Street Address
Address Line 2
City
State / Province / Region
Incident Information
Date of Incident
Time of Incident
Hours
:
Minutes
Location of Incident
Case Number
Details of Comment, Compliment, or Complaint
It is important to include as many factual details as possible, so that the incident may be fully investigated.
Are there photographs or other files that you would like to submit with this complaint? If so, specify below what is to be included. An investigator will contact you regarding retreival of the files.
Details of files/photographs or information to be included
I certify these statements to be true and accurate to the best of my knowledge and belief:
(Required)
Name/Signature
Symptoms
Please elaborate on which symptoms you are experiencing.
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