Internal Affairs Unit Complaint Form | Office of the Sheriff | County of Santa Clara

Date of Incident

First Name

Last Name

Address

City

Zip

Residence Phone

Business Phone

Email

Witness Name

Witness Address

Witness City

Witness Zip

Witness Residence Phone

Witness Business Phone

Occurrence Location

Allegations (ex: rude, excessive force, improper conduct, etc.)

Associated Police Report (number or citation number)

Name of Involved Employee 1

Involved Employee #1's Badge Number

Involved Employee #1's Division

Name of Involved Employee 2

Involved Employee #2's Badge Number

Involved Employee #2's Division

Name of Involved Employee 3

Involved Employee #3's Badge Number

Involved Employee #3's Division

Statement

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