RESTRICTED WHEN COMPLETE

MUST BE READ OUT AND SIGNED BY THE PERSON MAKING THE COMPLAINT

I agree to the information provided within this form being used for case management and any other Policing purpose including Home Office Statistics and assessment.

Signed ……………………………………...

Date:

/

Div/Station:

1 /

Details of Complainant - Complete additional forms for additional complainants or interested parties

Surname: / First Names:
Address: / Title: / Mr/Mrs/Miss/Ms/DrMrMrsMissMsDr
Date of Birth
Tel. No:
Mobile no:
Occupation:
Postcode: / E Mail Address:
Preferred Method of Contact is by:
/ Telephone: Letter: E Mail: Third Party:
2 /

Details of Complaint

How Made: / Letter / E-Mail / Telephone / Personal Visit to: / Police Station
Date: / Time: / Person completing:
Date of incident: / Time of incident:
Location of incident:
Div / LAC Area:
Brief summary of incident (including details of injuries, if any)
3 / Detail the specific complaints made against employees, providing as much detail as possible. To record a formal complaint we must be able to determine exactly what an employee is alleged to have done. Generalisations are not sufficient.
In the opinion of the complainant, does the complaint relate to any of the following:
Racial / Homophobic / Religion / Mental health / Sexuality / Disability
4 / Member(s) of the Police Service Subject of Complaint (Continue on separate sheet if necessary)
Rank / Grade / ID Number / Name / LAC
5 / Withdrawn / Not Proceeded With
I have discussed my complaint with:……………….…………………………………and am satisfied with the explanation given. I now wish to withdraw/not proceed with my complaint. I accept that this will bring action on my complaint to an end and that it cannot normally be re-opened.
Signature of Complainant:…………………………….……………..Date:…………………….

Please complete Equality Monitoring Form and read the instructions on the last page for submitting form.

This complaint form must be submitted to PSD within 24 hours of the complaint being made.

G340 Initial Complaint Form RESTRICTED WHEN COMPLETE

v3.1 June 2012Page 1 of 2

RESTRICTED WHEN COMPLETE

5 Equality Of Service Monitoring Form (this will be destroyed)
Nottinghamshire Police is committed to providing Equality of Service in terms of dealing with members of the Public regardless of race, gender, marital status, colour, nationality, religion or belief, ethnic or national origin, sexual orientation, age or disability. This commitment applies to all issues in relation to dealing with members of the public. In order that we may monitor and maintain Equality of Service would you please answer the following questions. However, if you would prefer not to say it will not affect your complaint in any way:
Gender: Male Female Other Prefer not to say
Sexual Orientation: Bisexual Gay/Lesbian Heterosexual Prefer not to say
Disability: No Learning Disability Learning Difficulty Mental
Physical Sensory Prefer not to say Other (specify)……………
Ethnicity:
White / British / W1
Irish / W2
Any other White background / W9
Mixed / White and Black Caribbean / M1
White and Black African / M2
White and Asian / M3
Any other Mixed background / M9
Asian or / Indian / A1
Asian British / Pakistani / A2
Bangladeshi / A3
Any other Asian background / A9
Black or / Caribbean / B1
Black British / African / B2
Any other Black background / B9
Chinese or / Chinese / O1
any other / Any other Ethnic Group / O9
Ethnic Group / Not Stated / NS
Religious Belief/Faith:
Agnostic / Evangelical /
Presbyterian
Anglican / Free Church / Protestant
Atheist / Greek Orthodox / Quaker
Baptist / Hindu / Roman Catholic
Brethren / Islamic/Muslim / Sikh
Buddhist / Jehovah Witness / Salvation Army
Ch Scientist / Jewish / Spiritualist
Chapel / Church of Ireland / Unitarians
Christian / Latter-Day Saints / United Reform
Church of England / Methodist / None
Church of Scotland / Mormon / Not Known
Church of Wales / Non Conformist / Other
Congregationalist / Pentecostal / Prefer not to say

THIS FORM MUST BE SUBMITTED TO PSD WITHIN 24 HOURS OF THE COMPLAINT BEING MADE. SEE INSTRUCTIONS ON NEXT PAGE FOR HOW TO SUBMIT THE COMPLAINT

INSTRUCTIONS ON SUBMITTING COMPLAINT

NOTE: THESE INSTRUCTION AND SUBMISSION BUTTON ARE NON-PRINTING AND WILL NOT APPEAR ON YOUR FINAL PRINTED DOCUMENT.

You must follow these steps in the sequence outlined below:

Step 1

Complete this form, including the Equality Monitoring Form in full

Step 2

Click on the button below to automatically email the complaint form to PSD. This will automatically email the form and delete the equality monitoring form. You will receive an automated response from PSD

Step 3

If there are injuries, complete medical consent form and send to PSD by mail or fax to ext 800 2564

LOCAL RESOLUTION SHOULD BE ATTEMPTED WHEREVER POSSIBLE ON FORM G340A

If the complainant decides to withdraw their complaint, print this form and get them to sign the statement declaration at box 5. you must then send this signed hard copy to PSD by mail or fax to 800 2564