Office of the Independent Police Auditor Complaint Form

OIPA Logo

300 Lakeside Drive, 14th Floor, Oakland, CA 94612
P.O. Box 12688, Oakland, CA 94604-2688
Phone: (510) 874-7477 Fax: (510) 874-7475
oipa@bart.gov | www.bart.gov/policeauditor

1. About You

  First Name  Last Name  M.I.
  Street  City  State  Zip
Best Time to Contact You
E-mail Address
Primary Phone
Alternate Phone
Gender
Age
Are you

2. About the Incident

Date and Time of Incident

Location of Incident (Please be as descriptive as possible -- any information listed may prove helpful in investigating your complaint.)

If yes, please describe your injuries:

Were you treated by a medical professional?
Were you arrested?
Are criminal charges pending?
Are you represented by legal counsel with regard to this incident?

If yes, please supply contact information for your attorney:

3. Victim/Witness Information

NameStatus:
(Victim or Witness)		AddressPhone

4. Involved Police Officer Information

Badge NumberNameSexRaceDescription
Were any of the officers in a police car?

If yes, please provide any identifying information that you have about the car(s):

5. Incident Description

Please describe the incident that forms the basis of your complaint. The more detail you are able to supply, the better equipped an investigator will be to conduct a thorough investigation:

6. Verification

  In order to submit your complaint you must first check this box to verify that the information you are submitting is true, to the best of your knowledge.