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Department Feedback

2. 

3. SEQUIM POLICE DEPARTMENT
   Department Feedback Form

   Department Feedback Form

5. First Name

6. Last Name

7. Email / Telephone

   If you'd like to be contacted by the Department, please provide an email address or telephone number

9. Address1

11. Address2

13. City

14. State

15. Zip

17. FEEDBACK SUMMARY

19. Incident Date/Time
    Incident Date/Time

    Incident Date/Time

    If feedback is related to a specific incident, please provide the date and approximate time of the incident

20. Incident Number

    If feedback is related to a specific incident, please provide the incident number

21. Video Available

    1. Yes
    2. No

    Is there video footage of the related incident?

22. Type of Feedback

    1. Positive Comment
    2. Complaint
    3. Suggestion

24. FEEDBACK

26. INVOLVED OFFICERS
    If related to a specific incident or event involving officer response, please provide the names of the responding officers

    If related to a specific incident or event involving officer response, please provide the names of the responding officers

28. Name

29. Badge Number

31. Name

32. Badge Number

34. Name

35. Badge Number

37. OTHER INVOLVED PARTIES
    If related to a specific incident, please provide information regarding other involved parties and/or witnesses

    If related to a specific incident, please provide information regarding other involved parties and/or witnesses

39. Name

40. Address

41. Phone

43. Name

44. Address

45. Phone

47. Name

48. Address

49. Phone

Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field