HAWAI‘I POLICE DEPARTMENT
Office of Professional Standards
349 Kapiolani Street
Hilo, Hawai‘i 96720
(961-2328)

 Written Complaint

 

YOUR NAME: ________________________________

DATE: ________________

ADDRESS: ______________________________

PHONE: ___________________

LOCATION OF INCIDENT: ___________________________________________

DATE OF INCIDENT: ___________________

TIME OF INCIDENT: ___________

ACCUSED EMPLOYEE: _____________________________

BADGE NO.:_______

 

STATEMENT OF COMPLAINT
(Specific Complaint Against Individual Employee)

 

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Additional Sheets Attached ___

 

 

Subscribed and sworn to before me

This _______ day of _________, 20_____

Signed:___________________________

Date: ____________ Time: ___________

 

Notary Public, Third Judicial Circuit
State of Hawai‘i
My Commission Expires: __________

 

(Notary Certification to be affixed)

 

HPD/OPS-001 (PO/FORM GO 302-A) (04-25-12) OFFICE OF PROFESSIONAL STANDARDS