Date of contact with employee:  

Time of contact with employee:  A.M.   P.M.

Location of contact: (i.e., address, cross streets, business name, etc.)  

Employee's name, identification number (if known) and assignment (if known)

Employee Name:		ID#:		Assignment:
Employee Name		ID#:		Assignment:
Employee Name:		ID #:		Assignment:

What initiated your contact with the employee?
Please type the word yes in the appropriate space.

	Police Response to Your Call	Pick up Property
	Traffic Collision	Visit/release a Prisoner
	Made a Report at Police Station	Witness at a Police Investigation
	Other

What would you like to commend about the employee(s) performance?

Print Your Name:		Signature: Not necessary online
Your Address:		City:
Zip Code:

Telephone Number:

Note: You do not need to fill in either of the next two fields. Click on "Submit" to send. Thank You.

Employee's Signature:

Commanding Officer/Supervisor's Signature: