(Please print and return to room 1K8, fax to (405) 682-7861, or email to
[email protected])
Oklahoma City Community College Campus Police Formal Complaint Form
Complainant Information Name: _____________________________________
DOB: _______________
Age: ___________
Address: __________________________________________
Phone: __________________
Business: ___________________________________________
Phone: __________________
Student ID: _________________
Complaint Number: ________________________
OCCC Police Department Employee Name: (If Known) _____________________________ Description:
M/F
Approximate Age: _____
Race: ______ HT: ______ WT: _____
Hair Color: ______ Hair Style: ___________ Eye Color: ______ Spoke w/Accent: Y/N
Employee ID Number: ____________
Eye Glasses: Y/N
Built: ______
Facial Hair:
Y/N
Type Uniform/Clothing: ____________________Employment Position: ___________
Vehicle Operating: _____________________ Vehicle ID Number: ______________ Tag Number: __________ Miscellaneous Information: ___________________________________________________________________ __________________________________________________________________________________________
Alleged Incident/Complaint Type of Incident: ____________________________ Time & Date of Incident: _____________________ Location of Incident: ___________________ List of Other Specific Allegation(s)/Concern(s): 1. _______________________________________________________________________________________ 2.________________________________________________________________________________________ 3.________________________________________________________________________________________ 4.________________________________________________________________________________________ Complainant Initials: ________
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In the narrative, please describe or explain the actions that are alleged to have been committed by the OCCC PD Officer(s). _________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Complainant Initials: ________
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Narrative Portion Cont’d: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
If necessary, I will submit to a polygraph examination to help corroborate the allegation(s) I made concerning improper actions by an employee of the Oklahoma City Community College Police Department. Y/N
_________ (Complainants Initials)
I understand that taking a polygraph examination is voluntary. I do not have to take one if I choose not to. I further understand regardless of my decision to take a polygraph, this compliant will be fully investigated.
AFFIDAVIT I, _________________________________, have read (or someone has read to me) all the information on this form concerning my complaint(s) of what I believe to be inappropriate behavior by an employee of the Oklahoma City Community College Police Department. I fully understand the contents of the entire form, and believe all statements made by me are true and correct. I have initialed all errors and corrections, and placed my initials on the bottom of each page. I understand that if I falsified any information I could be subjected to criminal prosecution.
______________________________________ Signature of Complainant
_____________________ Date/Time
______________________________________
______________________
Signature of Supervisor Taking Complaint
Date/Time
______________________________________ Signature of Witness
______________________ Date/Time
(Oklahoma City Community College Police Department Supervisor taking report must witness Signature of complainant.)
Complainant Initials: ________
Submit
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