Complaint Form

Complaint Form

This form is intended for use by those who wish to file a complaint against a UCSF police officer for misconduct and who seek formal investigation of the matter. If you are not such a complainant and do not seek formal investigation, you may instead want to fill out the Feedback Form.

Complainant Information

Name*

Email Address*

Mailing Address

Phone Number

Age

Gender

Race/Ethnicity

Did you receive any injuries as a result of this incident?*

Yes

Please describe any injuries you received as a result of this incident.*

Today's Date*

Incident Narrative

Date of Incident*

Time of Incident*

Specific Location*

Where specifically did this incident occur? Please include building name, floor, room, landmark, or any other specifics.

Incident Description*

Please describe the incident that forms the basis of your complaint. It is important that you include a detailed factual description of the events that gave rise to your complaint.

Document Upload

Optional File Upload

Upload documents or evidence related to the incident here Limit upload to 3 files in .pdf, .doc, .jpg, or .png format please.

Drag and drop files here or

Allegations

Other Allegation*

Police Officer Information

Badge Information

(if known)

Name of Police Officer

(if known)

Gender of Police Officer

(if known)

Identifying Characteristics of Police Officer

(if badge number or name are not known)

Witness Information

Witness 1

If applicable, provide name, address, phone, and email of Witness 1.

Witness 2

If applicable, provide name, address, phone, and email of Witness 2.

Witness 3

If applicable, provide name, address, phone, and email of Witness 3.

Certification

Check Box to Acknowledge:*

You have the right to make a complaint against a police officer for any improper police conduct. California law requires a procedure to investigate such complaints. You have a right to a written description of this procedure. Complaints filed and any reports or findings relating to complaints must be retained for at least five years.

By checking this box, I am certifying that I understand the above information, and the information I provided is true and correct to the best of my knowledge

Send me a copy of my responses

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