Service Complaint Form

Print

Please correct the field(s) marked in red below:

INSTRUCTIONS:  Please complete this form and describe the incident that led to this complaint, telling what happened from beginning to end.  Be as clear and specific as you can be.  Describe what aspect(s) of the incident was improper (i.e. your specific complaint), and how it could be resolved to your satisfaction. You will be contacted for additional information.

 

If you need to file a crime report please contact the Chula Vista Police Department Dispatch Center (619) 691-5151.


1
Type of complaint:
Type of complaint:
2
Your Contact Information
Your Contact Information
3
Incident Information
Incident Information
4
Employees Involved
Employees Involved
5
Please list anyone who witnessed the incident:
Name Phone Number
Witness #1
Witness #2
Witness #3
Witness #4
6
Incident Details
  1. To receive a copy of your submission, please fill out your email address below and submit.
    CAPTCHA
    Change the CAPTCHA codeSpeak the CAPTCHA code
     
    View Full Site