Internal Affairs Complaint / Report form
 DEPARTMENT
 Rockaway Borough Police Department
 ORI NO.
 NJ0143400
 INTERNAL AFFAIRS CASE NO.
 
  PERSON MAKING REPORT (Complaints may be filed anonymously)
 NAME
 
 ALIAS
 
 ADDRESS
 
 CITY
 
 STATE
 
 ZIP
 
 PHONE
 
 DOB (mm/dd/yyyy)
 
 SSN
 
 AGE
 
 SEX
 
 RACE (optional for statistical purposes only)
 
 EMPLOYER/SCHOOL
 
 PHONE
 
 ADDRESS
 
 CITY
 
 STATE
 
 ZIP
 
INCIDENT
 NATURE OF COMPLAINT
 
 COMPLAINT AGAINST (NAME(s))
 
 BADGE NO(s)
 
 DATE (mm/dd/yyyy)
 
 
 TIME
 
 
 DATE/TIME REPORTED
 
  
 HOW REPORTED
 
 INCIDENT LOCATION
 
 DIST/AREA
 
 BEAT
 
 DESCRIPTION OF INCIDENT
 DESCRIPTION OF ANY INJURIES
 
 PLACE OF TREATMENT
 
 DOCTOR’S NAME
 
 DATE OF TREATMENT(mm/dd/yyyy)
 

 DATE
 
 COMMENTS