• You do not have to use your name. Anonymous reports are acceptable for statistical analysis of police conduct. However, anonymous reports may not be useable in preparing class action lawsuits. Please put your name if you can. If you are assisting someone in filling out this report and they do not want to use their name, it is important that the assistor put your name as having witnessed the report. 
• If you have experienced police misconduct more than once, you need to fill out a separate report for each incident.
• If you witnessed police misconduct, you do not need to personally know the victim in order to fill out a police misconduct report. 
• If you don’t know the answers to some of the questions, leave them blank. It’s ok if you didn’t see every single thing. Don’t guess! Even one false answer can ruin your whole report, because if one answer is wrong, then none are trustworthy.
• If a question concerns locations or distance, go back to the scene and check. 
• Attach additional pages wherever you need to in order to make your answers complete.

About You
I am o victim o witness
Today’s Date:
Your name (if victim or witness declines to give name and someone is helping them fill out the form, please give your name:
Address:
Phone:
E-mail:

About the Incident
Date of incident:
Time incident began:
Time incident ended:
Exact location of incident

About Witnesses
Describe witnesses and give their names, addresses, phone numbers, and e-mail addresses if you have them.
 
 
 

If there were any photographs, videos, or audio recordings made, give names, addresses and phone numbers of people who will have these:
 

About the participants. (If the incident involved more than one police officer or victim, use additional copies of this page. If there are more than one victim or officer and you don’t know their names, call them Victim1, Victim2, Victim3, Officer1, Officer2, Officer3, etc.

The Victim
Name:
Address:
Phone numbers:
Gender:
Race:
Age:
Complexion:
Height:
Weight:
Hair:
Facial hair:
Glasses:
Voice:
Marks, scars, tattoos:
Disabilities:
Clothing:

The Officer
Name: 
Check one: o CSU Police o Ft Collins Police 
o Larimer County Sheriff o Highway Patrol
Badge Number:
Rank: 
Gender:
Race:
Age:
Complexion:
Height:
Weight:
Hair:
Facial hair:
Glasses:
Voice:
Clothing/uniform, weapons:
Vehicle (make, markings, license):

Did a commanding officer arrive during the incident or was a one consulted? 

Did you get the name?
Badge number:
Rank:
 
 

The Incident

What happened leading up to the incident?

What was going on when police arrived?

Did the officers identify themselves?

Then what happened? What did the victim do? What did the officer do?
 
 
 
 
 
 
 
 

Were orders given (to disperse, lie down, etc.)? Who issued the order and what did they say? Did you or others have trouble hearing the order? If so, why? 

What did the officer and victim say during and after the incident? 
 
 
 
 
 
 
 
 

Did you hear the officer use swear words or hate speech (racist, sexist, or anti-gay words)? Did the officer say anything that was rude, unfair, or untrue? What tones of voice did people use?

Did the officer treat the victim disrespectfully? Describe.

Did the officer ask permission to search any person or place (bag, car, home)? How did the victim respond? What did the officer do then?

Did you see violence? Who was involved? What kind of violence was used (slap, punch, kick, arm-twisting, chokehold, pepper spray, nightstick, gunshot)? How many times was the victim struck? What part of the body was targeted? What position was the victim in (standing, bent over, kneeling, or lying down)? Was the victim handcuffed or being held down?
 
 
 

About injuries to Victim
What were the number and location of the victim’s injuries (scrapes, bruises, cuts, sprains, broken bones, bullet wounds)?
 
 

If victim died, where and when did it happen?
 

Describe any ambulance or medical staff which came (name, license plate, id number).
 

Name, address, and phone numbers of anyone with photographs or videotape of victim’s injuries (during or after the incident).
 
 
 
 

Was anyone’s property damaged or taken away? When and how?
 
 
 
 

Did the officer search the wrong person or place (car, home)? Was the wrong person arrested? 

Was there a warrant? What person or place was specified in the warrant?

About profiling
Did it appear that police stopped the victim because their car was special (either very old or very new and sporty)?
 
 

Did it appear that police stopped the victim because of race, income level, hair, tattoos, or any other personal profile?
 

How long has the victim lived in Fort Collins? If they don’t live here, describe their relationship to Fort Collins (work, come on weekends, just visiting…)

How many times has the victim been stopped, questioned, detained, and/or arrested by police in Fort Collins?

How many times in the last year has the victim been stopped, questioned, detained, and/or arrested by police in Fort Collins?

Anything else the victim would like to add about their experience with law enforcement in Fort Collins?
 
 
 
 
 
 
 
 
 
 

Go back to the scene of the incident and draw a diagram of the area. Show where you were during the incident. Show where the victim and officer were. Put in other landmarks like signs, parked cars, fences, benches, etc. Use arrows to show where people moved.