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Civilian Complaint Form

  1. All information contained in this report will be kept strictly confidential and will be submitted directly to the director of public safety.

  2. Instructions

    1. If you prefer your complaint to be filed anonymously, do not answer questions 1 through 6 a.

    2. If you wish to be informed of the disposition of your complaint by the Director of Public Safety, fill the report out completely (include business and residence telephone phone numbers).

    3. Item #7: Indicate the date and time you are making your Civilian Complaint.

    4. Item #8: Indicate the day, date and time that the occurrence you are filling this complaint about took place.

    5. Item #9: Give the best description of the Roosevelt Island Public Safety Officer(s)involved and their name and shield numbers, if known.

    6. Item #10: Give as complete an explanation as possible of what transpired, and the basis for your complaint.

    7. Seal your Civilian Complaint Report in an envelope and return to: Roosevelt Island Operating Corporation, 591 Main Street, Roosevelt Island, NY 10044.

  3. 5. Sex:

  4. 9. Description of Roosevelt Island Public Safety Dept. Personnel involved:

  5. Leave This Blank:

  6. This field is not part of the form submission.