Sheriff's Office Personnel Complaint Form

2. PLEASE READ BEFORE SUBMITTING: I understand that it is a violation of Section 718.6 of the Code of Iowa for a person who reports or causes to be reported false information to a fire department, a law enforcement authority, or other public safety entity, knowing that the information is false, or who reports the alleged occurrence of a criminal act knowing the act did not occur, commits a simple misdemeanor, unless the alleged criminal act reported is a serious or aggravated misdemeanor or felony, in which case the person commits a serious misdemeanor. In the event the report is proven to be false, the information may be submitted to the County Attorney for possible prosecution. As provided in Section 80F.13 of the Code of Iowa, a deputy shall have the right to bring a cause of action against any person, group of persons, organization, or corporation for damages arising from a false complaint.

4. REPORTING PARTY (Complainant)
6. First Name
7. Last Name
9. Date of Birth
   Date of Birth
10. Age
11. Gender
12. Race
14. Home Address
16. City
17. State
18. Zip
20. Home Phone
21. Work Phone
23. Email Address
25. EMPLOYEE(S) INVOLVED
27. Employee Name
28. Badge #
30. Employee Name
31. Badge #
33. Employee Name
34. Badge #
36. Employee Name
37. Badge #
39. WITNESS(ES)
41. Witness #1
43. First Name
44. Last Name
46. Date of Birth
    Date of Birth
47. Gender
48. Home Phone
50. Address
52. City
53. State
54. Zip
56. Witness #2
58. First Name
59. Last Name
61. Date of Birth
    Date of Birth
62. Gender
63. Home Phone
65. Address
67. City
68. State
69. Zip
71. Witness #3
73. First Name
74. Last Name
76. Date of Birth
    Date of Birth
77. Gender
78. Home Phone
80. Address
82. City
83. State
84. Zip
86. Witness #4
88. First Name
89. Last Name
91. Date of Birth
    Date of Birth
92. Gender
93. Home Phone
95. Address
97. City
98. State
99. Zip
101. INCIDENT INFORMATION
103. Date of Incident
     Date of Incident
104. Time of Incident
     Time of Incident
105. Location of Incident
107. Narrative
109. Attachment
111. Are you requesting return contact?*

     1. Yes
     2. No
Leave This Blank:


113. 1. Receive an email copy of this form.
114. Email address

     This field is not part of the form submission.

115. Submit

* indicates a required field