Online Personnel Complaint Form
This form is only used for complaints of misconduct involving Los Angeles Police Department employees. The Los Angeles Police Department does not investigate employees of other Lo Angeles (LA) City departments, such as the Department of Water and Power or the Bureau of Sanitation, nor does it investigate LA County agencies, such as the LA County Sheriff’s Department. If you need to reach another LA City department, call 3-1-1 for assistance or find additional information online.

If you need the Personnel Complaint Form in Spanish, click here. If you require assistance in a different language, please call the 24-hour toll free hotline at (800) 339-6868.
Sign in to Google to save your progress. Learn more
Your Information (Today's Date) *
MM
/
DD
/
YYYY
First Name
Last Name
Middle Name
Gender
Clear selection
Descent
If Not English Speaking, Primary Language
Clear selection
Address
City
State
Zip Code
Mailing Address (If different)
City
State
Zip Code
Home Phone
Work Phone
Mobile Number
Email Address *
Date of Birth
MM
/
DD
/
YYYY
Driver Licence Number
State
Information about the Incident
Date of Incident *
MM
/
DD
/
YYYY
Time
Time
:
Has this complaint or any related complaint been reported before?
Clear selection
If yes, Case Number
Arrest?
Clear selection
Booking Number (If known/applicable)
Police Report Number (If known/applicable)
Location of Incident *
Involved Officers/Employees
Do you know the officer/employees’ names? List any additional officers/employees in theSummary.
Clear selection
Officer/Employee 1 & Badge or Serial No.
Officer/Employee 2 & Badge or Serial No.
Officer/Employee 3 & Badge or Serial No.
Officer/Employee 4 & Badge or Serial No.
Witnesses
Do you have names of any witnesses and their contact information? List any additional witnesses and their contact information in the Summary.
Clear selection
Witness 1 Name, Address, and Phone No.
Witness 2 Name, Address, and Phone No.
Witness 3 Name, Address, and Phone No.
Summary
Please provide a summary of the incident. Include additional officers/employees and witnessesnot listed above.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms