Excessive Force Reporting Form

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Please use this form to report incidents of excessive force used by the Denver Police Department during the protests that have taken place in Denver in response to the killing of George Floyd in Minneapolis.

Disclaimer: This survey has been designed to collect information from those affected by police excessive force during these protests. It is completely voluntary and identifying information will be kept confidential, to be used only for follow-up. This information is being collected for use by local legislators to inform policy change recommendations in the City of Denver.

Email *

First name *

Last name *

Phone number *

Zip code *

If you are submitting this form on behalf of the person listed above, please provide your (the proxy's) name and contact information.

Date of incident *

YYYY

Time of incident *

Time

Location of incident *

I was a (check any that apply): *

Participant in the protest

Bystander

Street medic

Member of the press

Resident of the neighborhood

Other:

Required

Did you sustain any injuries? *

Yes

Description of incident *

If you have photo, video, or some other form of documentation of the incident, please indicate that (and the type of media) here. Please email your media files to District9@denvergov.org, with the subject line "Excessive Force Documentation" + your last name.

Please provide names and contact information for any witnesses who would be willing to confirm this report.

What outcome would you like?

Submit

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