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) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 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