Report #
Internal Control #
Address
City
State
Zip
Home Phone
Work Phone
Employer
Address
Nature of Incident
Location of Incident
Name and Badge # of Officer (s)
Date and Time of Occurence
Date and Time Reported
How Reported
Description of Incident
Description of Injuries (if any)
Witnesses if Any (include phone number)
Professional Standards
Shift Supervisor
Other
Signature
Badge #
Date
Name
Action Requested
This form can be used to report and incident or information of any kind that should come to the attention of the Amity Township Police. You may record a complaint, a commendation for an officer or concerns of a public safety nature. Your report can be anonymous. However, in the case of an anonymouns complaint, said anonyminity may hamper a thorough investigation of the complaint. All submissions will be reviewed by the Chief of Police.
Professional Standards Unit
Information Form
(Department Use only) Investigation Forwarded to:
Amity Township Police Department
2004 Weavertown Rd., Douglassville, PA 19518
610-689-6002