Civilian Complaint Form
This form is also available 24/7 at Orange Police Headquarters - 314 Lambert Road, Orange CT. It is available during regular business hours at Orange Town Hall - 617 Orange Center Road, Orange CT and High Plains Community Center - 525 Orange Center Road, Orange CT. Inquiries can be made by calling the Office of the Chief at 203-891-2136 during regular business hours or the Shift Supervisor 24/7 at 203-891-2130. Complainants can remain anonymous. A copy of our Department Policy regarding complaints is available on our website. A Spanish version of our form is also available on our website.
Date of Incident
MM
/
DD
/
YYYY
Time of Incident
Time
:
Location of Incident
Your answer
Complainant's Name
Your answer
Complainant's Address
Street, City, State, Zip
Your answer
Complainant's DOB
MM
/
DD
/
YYYY
Complainant's Home Phone #
Your answer
Complainant's Work Phone #
Your answer
Complainant's Cell Phone #
Your answer
Complainant's Email
Double check your email! We send you a copy of the form to sign to this address! If it is incorrect, you will be unable to complete your application.
Your answer
Employer
Your answer
Occupation
Your answer
Employer's Address
Your answer
Employer's Telephone #
Your answer
Person Assisting Complainant's Name
Your answer
Person Assisting Complainant's Address
Your answer
Person Assisting Complainant's Telephone #
Your answer
Employee Complained About (if known)
Name or physical description, Badge #, Car #, etc.
Your answer
Witness Information
Name, DOB, Address, Telephone #, etc.
Your answer
Please provide answers to the following questions:
To your knowledge, was all or any part of the incident complained of video or audio taped by anyone?
Are you afraid for your safety, or that of any other person, for any reason as a result of making this complaint?
Has anyone threatened you or otherwise tried to intimidate you in an effort to prevent you from making this complaint?
Are you able to read, write, and speak the English Language?
If your answer to the previous question is "No" or "Unsure", have you been provided with adequate assistance to help you understand and fill out this form?
If you answered "yes" to any of the above questions, please provide details below.
Details of the Incident
Please provide a full description of the circumstances that prompted your complaint.
Your answer
Preferred method of Contact
Submission Instructions
After submitting, you will receive an email with an attached PDF containing your answers. Print the PDF, sign it, and give the completed document to a Police Supervisor or send it to the Office of the Chief of Police either at acuozzo@orange-ct.gov or by mailing to:

Office of the Chief of Police, Orange Police Department
314 Lambert Road, P.O. Box 617
Orange CT 06477

Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms