All fields marked with * are required.

Date and Time of Incident

Location of Incident *

Nature of Offence

County of Incident *

Can you identitify the police facility involved? *

Was the victim/complainant held for more than 24 hours *

Are there other steps required to assure safety of the complainant/victim? *

Does the victim/complainant need counselling? *

Were witnesses present? *

Provide names and phone numbers for witnesses

Narrate and expand on the complaint details *

Has the suspect officer been Identified *

First Name

Last Name

Other Names

Phone Number

Service Number

Color of Uniform

Gender

Description

Complainant held within police detention facility

County

Police Facility

Complaint Subject to Court Proceedings

Complaint Lodged in other institution

Institution Lodged

Lodged Complaint Detail

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