Your issue is important to the Asheville Police Department. In order to facilitate the process, please follow these simple directions: Whether your issue is complimentary of or a complaint against an officer, please fill out the form as completely as possible. Important information is the who, what, when, where and how of what happened to you. • If your issue is of a second hand nature or you were a witness to a matter of concern, please be clear on those facts. • We must be able to contact you for follow up investigation should it be warranted. Include an accurate day and night phone number, address and email address (if available). • A review of this matter WILL BE conducted by at least a command level employee of Asheville Police Department. • You will be informed of all matters material to the investigation within the guidelines of NC law. • If you have not been contacted directly within 10 working days please contact the Asheville Police Department office of Professional Standards at (828) 259-5907, or you may email the office of the Chief of Police at: Internet/police@ashevillenc.gov • Please deliver to a supervisor of the Asheville Police Department or fax to (828) 259-5823 or mail the completed form to: Professional Standards-Internal Affairs Asheville Police Department PO Box 7148 Asheville, NC 28802 ASHEVILLE POLICE DEPARTMENT CITIZEN REPORT OF EMPLOYEE ACTION CASE #:___________________ Complainant’s Name: ____________________________________________________________ Date of Birth (mm/dd/yyyy):________________ Race:_____________ Male _____ Female _____ Home Address: ____________________________________Home Telephone:_______________ Business Address: ________________________________ Work Telephone: _______________ Email address: _________________________________________ If applicable, list other complainants and/or witnesses: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Employee(s) Involved-names if known: (1)__________________________________________ (2) __________________________________(3)_______________________________________ Date of Incident (mm/dd/yyyy): ______________ Time of Incident: _________________________ Location of Incident: _____________________________________________________________ Complaint Received By: __________________________________________________________ Date (mm/dd/yyyy):_______________________Time:__________________________ Summary of Incident: (You may attach your own document if needed) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ The above information is complete and true to the best of my knowledge: __________________________________________ Date: _____________________________ Signature of Complainant Summary of Incident: (You may attach your own document if needed) Page_________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ The above information is complete and true to the best of my knowledge: _______________________________________ Date: ____________________________ Signature of Complainant