"To Protect & Serve"

Paterson Police Department

Paterson Police Raise $33,000 for Children's Cancer Research and Care

Division  ______________________________________________________________        IAD#               ___________________________________________________________________


INTERNAL AFFAIRS REPORT FORM

Person Making Report (Optional, But Helpful)

 

 

Full Name

 

 

Address

 

 

City, State

 

 

 

 _______________________________________________________

 

 

_______________________________________________________

 

 

 _______________________________________________________

 

                 

                                                                                                    Preferred?

Phone  _______________________________________________________   

 

 

Email   _______________________________________________________   

 

 

DOB     ______________________________________________________________

 

Officer(s) Subject to Allegation (Provide Whatever Info Is Known)

 

 

Officer(s)

 

Incident Site

 

 

 

 _______________________________________________________

 

 _______________________________________________________

 

                 

                                                                                                   

Badge No.    ____________________________________________________   

 

Date/Time    ____________________________________________________

 

In the space below, describe the type of incident (traffic stop, street encounter) and any information about the alleged conduct. If you cannot fit your response below, feel free to use extra pages and attach them to this document. If you do not know the officer’s name or badge number, provide any other identifying information.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Other Information

 

How was this reported?  □ In Person   □ Phone    □ Letter    □ Email    □ Other __________________________

 

Any physical evidence submitted?  □ Yes   □ No   If yes, describe:  __________________________________________

 

Was incident previously reported?   □ Yes   □ No   If yes, describe:  __________________________________________

 

To Be Completed by Officers Receiving Report

 

 

 

 

_______________________________________________________________________________________________________       _________________________       _______________________

Officer Receiving Complaint                                                Badge No.          Date/Time

 

 

_______________________________________________________________________________________________________       _________________________       _______________________

Supervisor Reviewing Complaint                                         Badge No.          Date/Time