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Civilian Complaint Form

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

4. Instructions

   1. If you prefer your complaint to be filed anonymously, do not answer questions 1 through 6 a.<br><br> 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). <br><br> 3. Item #7: Indicate the date and time you are making your Civilian Complaint. <br><br> 4. Item #8: Indicate the day, date and time that the occurrence you are filling this complaint about took place. <br><br> 5. Item #9: Give the best description of the Roosevelt Island Public Safety Officer(s)involved and their name and shield numbers, if known. <br><br> 6. Item #10: Give as complete an explanation as possible of what transpired, and the basis for your complaint. <br><br> 7. Seal your Civilian Complaint Report in an envelope and return to: Roosevelt Island Operating Corporation, 591 Main Street, Roosevelt Island, NY 10044. <br><br>

   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.
   
   

6. 1. If you prefer to file this report anonymously, check the box to the left. (Do not answer questions 1 to 6a below.)

8. 1. Complainant’s Last Name, First

10. 2. Business Telephone Number

12. 3. Complainant’s Address

13. Apt. #

15. 4. Residence Telephone Number

17. 5. Sex:

    1. Male

    1. Female

19. 6. Age

20. 6a. Date of Birth
    6a. Date of Birth

22. 7. Date & Time Reported
    7. Date & Time Reported

24. 8. Day, Date & Time of Occurrence:
    8. Day, Date & Time of Occurrence:

    8. Day, Date & Time of Occurrence:

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

28. Sex

29. Color

30. Age

32. Height

33. Weight

34. Shield Number and Name (if known)

36. 10. Details of Incident and/or Basis for Complaint:

38. Complainant’s Signature

42. Date Received by Director
    Date Received by Director

44. Date Investigation Started
    Date Investigation Started

46. Investigator

48. Additional Comments

Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field