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Complaint against the police  
The OIPRD must have a signed form with the details of your complaint before we can begin to process the information.
Please make sure that you sign the declaration number 4.a. on this form.
 
If you have filed this complaint with another government agency, police service, or this matter is currently before the courts please indicate below:
 
  I have filed this complaint with another government agency or police service.
If Yes, please specify :
 
  This matter is currently before the courts.
 
Completing the form
The information in this form will be forwarded to the appropriate police complaints authority for consideration. This includes a professional standards department or police authority of the relevant police service.

We advise not to use special characters or symbols on this form.
If you have difficulties in filling out this form, or have any questions about the complaints process and would like to speak to the OIPRD prior to filling out the form, please call us at 1-877-411-4773 or 416-246-7071. If you would like someone to act on your behalf please indicate so in 4. a. If a translator assisted you, please provide their details in addition to your own at the end of this form (in this case both parties must sign – see 4. b.).
1. Your details (complainant)
Please give us your contact details.
* Title: (required)  
* Given name: (required)  
* Family name: (required)  
* Date of birth: (required)   Day Month Year
* Street address: (required)  
   Street address:  
* City: (required)  
   Province:  
   Postal code:  
   Work telephone number:   --
* Home telephone number: (required)   --
   Cell phone number:   --
   Email:  
 
  * I would like correspondence from the OIPRD to be sent to me by: (required)
 
 
  * This is a complaint about something that happened to: (required)
 
2. Police details
WHO? Which police service is your complaint about?
   * Police service: (required)
     
 
    If your complaint is against a specific officer(s), please give us any details you might have about the police officer(s) you would like to make a complaint against:
 
   Name:  
   Rank:  
   Badge No.:  
   Any other identifier (e.g., age, height):  
 
   Name:  
   Rank:  
   Badge No.:  
   Any other identifier (e.g., age, height):  
 
   If you know the police station where the officer(s) work, please give details:
  
 
3. Your complaint details
WHERE? Where did the incident(s) that led to your complaint happen? Please fill in as much of the information as you know. If you do not know any specific details you may wish to include details of landmarks, etc.
   Street address:
   Nearest intersection:
  *  City: (required)
   * Any other details: (required)
  
 
WHEN? When did the incident(s) happen? If there is more than one date, please specify when the incidents occurred below. (* required)
 
   Date:   Day    Month    Year
   Time:   Hour   Minute
 
   Date:   Day    Month    Year
   Time:   Hour   Minute 
 
   Date:   Day    Month    Year
   Time:   Hour   Minute 
 
   Date:   Day    Month    Year  
   Time:   Hour   Minute
 
             Or indicate the time period when the incident(s) occurred.
   From:   Day    Month    Year
   To:   Day    Month    Year
 
WHAT? Please describe the circumstances that led to your complaint. Please include details of:
     · Who was involved
     · What was said and done
     · Any other people who witnessed the incident (including other police officers)
     · If there was any damage or injury
     · If there was something that you feel caused the incident or affected your interaction with the police
     · If there is any evidence to preserve (e.g., medical records, photos, videos)
     · If this happened to someone else, the name and contact information of that person (if known).
 
At this stage we only require a summary of your complaint, but you may send additional information or documents if necessary.
   * Summary of your complaint: (required)
  
 
4.a. Declaration
I, (enter name below) certify that the information provided is true, and I am not excluded from making a complaint about this police service. I understand the information on this form will be forwarded to the appropriate authority for consideration.
(This includes a professional standards department or police authority of the relevant police service).
Name: (required)  
*  Signature: (Acknowledge by selecting 'Yes') (required)  
    Date (mm/dd/yyyy):  
 
    I am represented by an agent:   
           Name of agent:   
           Please enter the contact details of your agent: 
          
 
4.b. Translator’s Declaration
I, (enter name below) declare that I have accurately translated the entire content of this form to the complainant from the English/French language to (enter language below). I am proficient in both languages and was able to communicate fully with the complainant. The complainant has indicated that s/he fully understands the entire content and the answers provided.
Name: (required)  
Language: (required)  
*  Signature: (Acknowledge by selecting 'Yes') (required)  
    Date (mm/dd/yyyy):  
 
Additional information
Please indicate if you need to be accommodated in the event of an interview by checking the appropriate boxes or filling in the section below:
   I used a translator to fill out this form, and I will need to arrange for a translator in the event of an interview. 
   I will require a telephone typewriter service for interviews over the phone and my translator to be present for in person interviews. 
 
   If there is any other information you feel is important please indicate it below:
  
 
Freedom of Information and Protection of Privacy
Personal information on this complaint form is collected and provided to the OIPRD by the Police Services Act (section 57 and/or 58) and will be used to investigate your complaint. If you have any questions about privacy protection and the Ontario government, please call the OIPRD at 1-877-411-4773 or visit our website at www.oiprd.on.ca.

 
OIPRD-FEB-10-2012