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This document is an internal affairs report form, written in Polish, for a municipal department (likely public safety). It is designed to collect details regarding complaints or incidents involving officers. The form requests information about the person submitting the report (optional, but helpful), the officer(s) involved in the alleged misconduct, the location, date, and time of the incident, and a description of the event. It also includes sections for identifying how the report was submitted (in-person, phone, mail, email, other), whether material evidence was presented, and if the incident was previously reported. Finally, there are fields for the officer receiving the complaint and the supervisor reviewing it to fill out.