Police Complaints

2. Any person may make a complaint about police conduct directly to the Brookline Police Department, or to the Select Board. To complain directly to the Police Department, use the Police Dept. Civilian Complaints Page. Alternatively anyone may make such a complaint through the Police Commissioners Advisory Committee, by filling out this form and submitting it here. When the PCAC receives a complaint, it reviews the complaint and transmits it to both the Police Department’s Office of Professional Responsibility and the Select Board, along with any observations or recommendations of the PCAC. Sarah Kaplan, the PCAC’s Liaison to the Diversity Office, is available to assist a complainant with the complaint process at [email protected].

4. 1. Complainant Information
6. Are you willing to identify yourself?*

   1. Yes
   2. No, I'd like to remain anonymous
8. Name
9. Home Address
11. Telephone
12. Cell Phone
14. Email Address
16. Other Contact Location (Optional)
17. Other Telephone
19. Age
20. Date of Birth
    Date of Birth
22. Gender
23. Race
27. 2. Incident Information
29. Day, Date & Time of Incident
31. Location of Incident
33. Name of Accused Employee

    Please provide the employee's name and badge number if you know it.

34. Badge No.
36. Description of Employee*
38. Name of Second Accused Employee

    If another employee was involved, please provide a their name and badge number if you know it. Otherwise, leave this blank.

39. Badge No.
41. Previous Contacts with Accused Employee(s)

    1. Yes
    2. No
43. If Yes, When and Circumstances
45. Other Employees Present

    Please list any other employees who may have been present at the time of this current complaint.

47. Other Evidence or Documentation to Support Allegations

    1. Yes
    2. No
49. If Yes, Describe
53. 3. Witness Information

    Please identify all witnesses (for example, eyewitnesses) whom you believe possess information relevant to the complaint.

55. Name
56. Address
58. Telephone
59. Cell Phone
61. Email
63. Age
64. Date of Birth
    Date of Birth
66. Gender
67. Race
69. Description If Not Identified (Including Clothing) or other information that will assist with identifying the witness:

71. Fill out the following fields if there was a second witness. Otherwise, leave these fields blank.

73. Name
74. Address
76. Telephone
77. Cell Phone
79. Email
81. Age
82. Date of Birth
    Date of Birth
84. Gender
85. Race
87. Description If Not Identified (Including Clothing) or other information that will assist with identifying the witness:
89. If more witnesses, please add additional witness information.
93. Complainant Injuries

    Please describe all injuries as clearly as possible.

95. Injuries Claimed

    1. Yes
    2. No
97. If Yes, Describe
99. Injuries Visible

    1. Yes
    2. No
101. If Yes, Describe:
103. Doctor or Hospital Visited

     1. Yes
     2. No
105. If Yes, Who, When, Where and What Treatment Received:
107. Photos or Other Documentation Taken of Injuries

     1. Yes
     2. No
109. If Yes, Describe
111. Willing to Release Photos or Other Documentation:

     1. Yes
     2. No
112. Willing to Provide Medical Records

     1. Yes
     2. No
116. 5. Incident Narrative

     Describe incident in detail giving specific times, dates, locations, witnesses, conversations, and actions.

118. If you have previously provided a written narrative of the incident, i.e., email, letter, of the incident, do you wish this submission to serve as your narrative:*

     1. Yes
     2. No
120. If no, please provide an incident narrative
122. 6. Confidentiality
124. Please specify any information that you wish the Department to maintain confidentially, to the extent doing so is permissible under the law.
126. Please specify any information that you wish the Department to maintain confidentially, to the extent doing so is permissible under the law.*

     1. Willing To Sign
     2. Refused To Sign
     3. Unavailable To Sign
128. I hereby acknowledge that I have read this completed Citizen Complaint Form and that the statements and information contained herein are true to the best of my knowledge.
130. Signature of Complainant
132. I have reviewed the Brochure and Written Explanation of Citizen Complaint Procedures Provided to Complainant*

     1. Yes
     2. No

     Brochure

     Citizen Complaint Procedures

134. Date*
     Date
136. Email copy?

     1. Receive an email copy of this form.
138. Email Address
Leave This Blank:


140. 1. Receive an email copy of this form.
141. Email address

     This field is not part of the form submission.

142. Submit

* indicates a required field