Your Information:

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Address:

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Home Phone:
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Information about the Incident:

Location of Incident:

Date of Incident:
Time of Incident: AM PM

Name of SPD Officer/Employee(If known):

Name of Witness(es) or Others Involved:

Witness Address:

City: State: AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NW NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Zipcode:

Witness Phone:

Statement/Description of Incident:

OPA has a Citizen-Police mediation program to resolve certain complaints. Participation is voluntary. Would you consider mediation for this complaint?

The Office of Professional Accountability exists to ensure professional and accountable law enforcement for the citizens for Seattle. Honest feedback is essential to maintaining a police department that is both trustworthy and responsive to the community. Therefore, it is critical that truthfulness be maintained in the filing and investigation of complaints against the police.

I hereby certify that the information in this complaint is true and correct to the best of my knowledge and belief.

Initials: