Putnam Police Dept: Compliment-Complaint Form

Our mission is ‘to police our community with professionalism, integrity and compassion, working in harmony with our citizens to maintain a quality of life that promotes safe and secure streets and neighborhoods’. We are deeply committed to this – and as such, members of the department are held to the highest of standards.

Citizens are encouraged to bring forward legitimate complaints regarding possible misconduct or malfeasance and/or compliments regarding exceptional service of employees of this agency.

Please indicate the type of statement you are providing.*

Please provide general details about yourself.

Full Name*

First NameLast Name

Date of Birth*

Date

Phone Number*

Area CodePhone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Please provide details regarding the complaint of possible misconduct or malfeasance of an employee(s) of this agency.

Date & Time of Incident*

DateHourMinutesAM/PM Option

Date & Time Reported*

DateHourMinutesAM/PM Option

Location of Incident*

Name(s) of Persons Witness to Incident*

[Include contact details; Full Name, D.O.B., Phone Number)

Please provide details of the particular officer(s) in question - including full name and/or physical description, badge number, license plate, etc. if known.*

Please provide a full description of the circumstances that prompted your complaint.*

Supporting documents, including letters, emails, photographs, video and/or audio may be emails to; Chief Chris Ferace, Putnam Police Department at Christopher.Ferace@PutnamPolice.com

Please provide answers to the following questions:*

	YES	NO	UNSURE
To your knowledge, was all or part of the incident complained of video or audio taped?
Are you afraid for your safety, or that of any other perosn, for any reason as a result of making this complaint?
Has anyone treatened you or otherwise tried to intimidate your 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 Question #4 is "No" or "Unsure", have you been provided with adequate language assistance to help you understand and fill out this form?

In answering "YES" to one of the above questions, please provide additional details.

Please provide details regarding the compliments regarding exceptional service of an employee(s) of this agency.

Date & Time of Event*

DateHourMinutesAM/PM Option

Date & Time Reported*

DateHourMinutesAM/PM Option

Location of Event*

Please provide details of the particular officer(s) in question - including full name and/or physical description, badge number, license plate, etc. if known.*

Please provide a full description of the circumstances that prompted your compliment.*

Supporting documents, including letters, emails, photographs, video and/or audio may be emails to; Chief Chris Ferace, Putnam Police Department at Christopher.Ferace@PutnamPolice.com

I have read, or had read to me, the above statement. All of the answers are true and accurate to my knowledge. I understand that making a false statement intended to mislead a law enforcement officer in his/her official function is a violation of Connecticut General Statute 53a-157b and could result in my arrest and being fined and/or imprisoned.

Signature*

Date & Time Signed

DateHourMinutesAM/PM Option