Detroit Public Schools Office of Public Safety Documentation of Citizen Interaction Form

This form should be used to document your interaction Detroit Public Schools Community District Office of Public Safety (DPSPD) employee, including but not limited to acknowledgment of excellent service (polite, understanding, courteous, above and beyond) or a complaint (whose conduct, behavior, or actions is considered improper, unnecessary, inappropriate or unlawful).

Please TYPE all information on the spaces provided so the Department's has necessary information regarding your interaction with the employee. If you need assistance in completing this form, please contact the Officer-In-Charge of the station at 313-748-6000 0r come to 8500 Cameron St. Detroit, MI. You will receive notification at a later time about your submission confirming receipt and details of the next steps.

Make sure you send a copy of your responses to your email for record keeping.

TYPE of SUBMISSION

Your Name

Your Street Address, City, State, Zip Code

Your Phone Number

Phone

WORK PHONE NUMBER

Phone

Date of Incident

mm/dd/yyyy

Just start typing the name of the school that you were at

School Location or Associated School

Address or street location of Incident if not on DPSCD Property

Nature of Contact

Employee(s) Involved If Known)

Was employee wearing a uniform?

YES

Was this a traffic stop?

YES

Provide related police report# if available.

Witness #1 Name Address, phone Number

Witness #2 Name Address, phone Number

Witness #3 Name Address, phone Number

SUMMARY of Interaction with DPSPD Employee

In your own words, please describe your interactions with the employee(s). Please be detailed and specific as possible.

Summary of Interaction

Please upload a picture of your ID and any other documents you want to submit.

File Upload/or Photos

Drop your files here

Send me a copy of my responses

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