Employee Complaint Form

Complete the information for the complainant. It is important to include your telephone number in order that an investigator may contact you for additional information or clarification if needed. 

List any witnesses to the alleged employee misconduct. Indicate the name of the employee(s) if known. If the name is unknown, provide as much physical description about the employee(s) as possible. 

Describe the event in detail including date, time and location of the incident. 

Pressing the submit button on the form indicates that all information is true to the best of your knowledge. 

Today's Date MM/DD/YYYY
Your Full Name
Home Address
City, State, Zip Code
Phone Number
Date of Birth MM/DD/YYYY
Witness Name (1) Enter witness name or N/A if unknown
Witness Address (1) Street Address
Witness Address City, State, Zip Code
Witness Email:
Witness Name (2)
Witness Address (2) Street Address
Witness Address (2) City, State, Zip Code
Witness (2) Email:
Names of Employee(s) involved in complaint
Date of Incident MM/DD/YYYY
Location of Incident Street Address
Location of Incident City, State, Zip Code
Time of Incident HH:MM AM/PM
Description of Incident Describe what happened in detail.
Disclaimer Agreement I do hereby affirm that I wish to file a complaint against an employee of the Atlantic Beach Police Department. I further affirm that the information provided by me is true and complete to the best of my knowledge. I understand that any false, misleading or untrue statement(s), accusations or allegations made by me may subject me to Criminal and/or Civil prosecution. I further understand that in the course of an investigation of my complaint, I may be required to meet with a member(s) of the Atlantic Beach Police Department to discuss this complaint further.