Internal Affairs Report

Palmyra Internal Affairs Unit

Fields marked with an * are required

Person Making Report (Optional, But Helpful)

First Name

Last Name

Phone

Address

City

State

Zip

DOB

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

Officer(s) *

Badge No. *

Incident Site *

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? *

Was incident previously reported? *

Internal Affairs Report

Divisions

Palmyra Internal Affairs Unit