Internal Affairs Complaints Referrals Placeholder - Bergen County Prosecutor's Office

Person Making Report (Optional, But Helpful)

Full Name:

First

Last

Date of Birth:

Address:

City

State/Province

Zip/Postal

Phone:

Email:

Preferred Contact method:

Phone

Email

Agency Personnel Subject to Allegation (Provide Whatever Information is Know)

Employee Name(s):

Badge Numbers(s):

Incident Location:

Incident Date:

Incident Time:

Describe the Incident:

In the space above, describe the type of incident (traffic stop, street encounter) and any information about the alleged conduct. If you do not know the employee's name or badge number, provide any other identifying information.

Other Information

Any physical evidence submitted?

Yes

No

Please describe the physical evidence:

Was incident previously reported?

Yes

No

Please describe previous report:

Internal Affairs Report Form

Person Making Report (Optional, But Helpful)

Agency Personnel Subject to Allegation (Provide Whatever Information is Know)

Other Information

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