Name:         
Title:        
Address:      
City:          State:  Zip: 
Telephone:    
Fax:          
E-mail:       

Please contact me via: E-mail US Mail Fax Phone Do not Contact  

Complaint #:"If Know"    
Date:                  
Time:                  

Nature of Complaint:   

Dispatcher Receiving:  
Officer(s) Detailed:   

1. Did the dispatcher adequately identify themselves to you? Please Select One Yes No
2. Was the dispatch courteous and considerate while speaking with you? Please Select One Yes No
3. Did the dispatcher solicit information in a calm and businesslike manner? Please Select One Yes No
4. Upon the completion of your conversation, did you feel that your problem was going to be properly investigated and/or solved? Please Select One Yes No
5. To the best of your knowledge, was your problem properly investigated and/or solved? Please Select One Yes No
6. Did a police officer make a personal contact with you? Please Select One Yes No
7. Do you have any additional comments that you would like to make regarding the contact that you had with the Elyria Police Department dispatch personnel?     

If you did not have personal contact with an Elyria Police Department police officer, STOP here.  If you did have personal contact with an Elyria Police Department police officer, please complete the Officer Review section.

1. Did the police officer(s) respond to the scene in a satisfactory amount of time? Please Select One Yes No
2. Did the officer(s) adequately identify themselves to you? Please Select One Yes No
3. Was the officers(s) courteous and considerate while speaking with you? Please Select One Yes No
4. Did the officer(s) conduct themselves in a fair, impartial and business-like manner? Please Select One Yes No
5. Did the officer(s) take a positive action regarding your complaint and adequately explain their actions? Please Select One Yes No
6. Upon the completion of your contact with the officer(s) did you feel that your problem was properly investigated and/or solved? Please Select One Yes No
7. Were you satisfied with the overall service that you received from the Elyria Police Department? Please Select One Yes No
8. Do you have any additional comments that you would like to make regarding the contact that you had with the Elyria Police Department?