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* Indicates required question
Date of Incident
When did the incident occur?
MM
/
DD
/
YYYY
What was the location of the incident?
*
Enter the street address, city, state and zip code
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What type of incident was it?
*
Excessive Force
Harassment
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Description of Incident
Tell us about what happened
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Officer Gender
Male
Female
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Office Race/Ethnicity
What is the officer's ethnicity/race?
White
Latino/Hispanic
African American
Asian
Other:
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Other Officer Information
Enter officer badge number, license plate number, etc
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Officer 2 Gender
If there was a second officer, enter officer information here
Male
Female
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Officer 2 Race/Ethnicity
If there was a second officer, enter officer information here
White
Hispanic/Latino
African American
Asian
Other:
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Multiple officers
If there were more than two officers involved, please enter information here
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