598708 fdca3f43a82148c2aaa35282066049a9

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Executive Summary

This document is a form for reporting internal affairs. It allows individuals to report incidents, providing details such as the location, date, and time of the event, as well as any information about the involved agent. The form also includes sections for reporting the incident and any supporting evidence.

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Automated discovery link found on Northvale website.

Document Text

--- Document: 598708 fdca3f43a82148c2aaa35282066049a9 Document ---
Depatman/Ajans __________________________________________ 
Nimewo Dosye IA_____________________________________ 
FÒMILÈ POU RAPÒ SOU ZAFÈ ENTÈN 
Moun k ap pare rapò a (Fakiltatif, men li itil) 
 
 
Non konplè 
 
Adrès (Nimewo 
Apatman) 
 
 
Vil, Eta, Kòd Postal 
 
_______________________________________________ 
_______________________________________________ 
_______________________________________________ 
 
 
Telefòn 
 
Adrès 
elektwonnik 
 
 
Dat nesans  
 
Preferans? 
________________________________  □ 
 
 
________________________________  □ 
 
 
 
 
___________________________________   
Ajan ki ankòz nan deklarasyon an (yo) (Bay tout efòmasyon ou konnen) 
 
 
Non Ajan an (yo) 
 
Kote ensidan  
an pase 
 
_______________________________________________ 
_______________________________________________ 
 
 
Nimewo ekison 
 
 
Dat/Lè 
 
 
 
___________________________________   
 
 
___________________________________   
Nan espas pi ba la a, dekri ki kalite ensidan ki te rive (panno estòp nan lari, kwaze nan kafou) epi bay tout enfòmasyon ou genyen sou zak lòt 
moun lan fè a. Si ou pa rive jwenn repons ou pi ba la a, ou mèt sèvi avèk paj siplemantè epi tache yo ak dokiman sa a. Si ou pa konnen non 
Ajan an, ni nimewo ekison li, bay nenpòt ki lòt enfòmasyon ou genyen pou idantifye li. 
Lòt enfòmasyon  
 
Kouman rapò a te fèt? 
□ Prezante an pèsonn □ Nan telefòn 
□ Nan lèt □ Nan kourye elektwonnik 
□ Lòt jan    _________________ 
 
Èske ou te remèt okenn prèv materyèl?  
□ Wi 
□ Non 
Si ou di Wi, esplike:  ________________________________________________ 
 
Èske ensidan an te rapòte anvan sa?  
□ Wi 
□ Non 
Si ou di Wi, esplike:  _____________________________________________ 
 
Kite plas anba la a pou Ajan k ap resevwa rapò a 
 
 
_______________________________________________________________________________ 
_______________ 
_______________ 
Ajan k ap resevwa plent lan  
Nimewo ekison  
Dat/Lè 
 
 
_______________________________________________________________________________ 
_______________ 
_______________ 
Sipèvizè k ap resevwa plent lan 
Nimewo ekison  
Dat/Lè