Policy Text
S:\UCSFPD \Forms_Templates \Complaint_Compliment_IIR Form v1.docx Revised: 5/12/2023
UCSF Police Department
Complaint or Compliment Form
Date of Inci dent:
Reported By:
Name:
Address:
Phone Number : email Address:
Involved Employee (s) or Unit :
Nature of Incident:
Witnesses (if any):
To Be Completed by Intake Personnel :
Date & Time Received: Received By:
Manner Received:
Counter Report
Phone
email Fax
Other:
Action Taken:
This form constitutes an Informal Inquiry Report (all of the following are true ):
A complaint is involved, but there is no allegation of neglect of duty or serious misconduct (PC § 13510.8 ,
GO 3.42.4 B.3) .
All of the complainant’s concerns have been addressed and resolved to his/her satisfaction .
The complainant has been informed that the complaint is being classified as an Informal Inquiry, understands
that no formal investigation of an Informa l Inquiry is conducted and is satisfied with this resolution.
Form Completed By: Date:
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Routing: Forward the completed form to the Professional Standards Division Commander .
Complainant Notified of Disposition By: Date: (formal complaints only)
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