CRIME REPORT
or
REQUEST FOR ASSISTANCE


You may use this form for any of the following:


Notice !

No action will be taken on submissions containing incomplete data and/or submitted anonymously.

The time required to process each report varies from several minutes to many weeks, depending on the complexity and severity of the issues involved.

_____________________________________

So you may better understand the process involved, below is a list of steps taken with each report received:

The report is sent to the Case Screening Unit for processing, (as follows.)

Case is sent to Central Dispatch for assignment, (as follows.)

This is a thorough and time consuming process. Depending on the many factors involved, this process may take from 1 day up to several months to complete, Please be patient. We will make every attempt to resolve this matter quickly and to the satisfaction of all those involved.

No "updates" or "requests" for information regarding any case will be provided to anyone except the original complainant, and then only if the request is submitted using this form.
ALL such requests will be authenticated before releasing any information!


All Information is required !

Select your purpose for submitting this Report:

If this is a formal complaint, please select the type of complaint:


Today's date is: (select below)

 

Please provide the following information about yourself:

First Name:

Middle Name:
Last Name:
Title or Position:
E-mail Address:

Postal Address:
City:
State / Province:
Postal Code: (Zip)
Country of Residence:
Telephone Number:
Are you an Adult or Minor in your Country of residence?


1. Is there a Minor involved in this complaint? Yes No

2. Is this your first complaint on this issue? Yes No

3. Have you filed a report with us on this issue earlier? Yes No

4. If "Yes," What is the case number that was assigned to you?

  Case # if Applicable:

5. Is this complaint an offline (non-internet) issue? Yes No

6. Is this complaint an online (internet) issue? Yes No

7. Is this complaint both an offline/online issue? Yes No

8. Have you filed a complaint with a law enforcement agency? Yes No

If yes, please give details below:

 

Please describe, in detail, your complaint or request (include any useful information, persons involved, etc, in this space):

Please provide all evidence in the box below. Copy and Paste ONLY your supporting information (photos, emails, images, etc). Attachments will be rejected! If, for any reason, you are unable to copy and paste your information, you can send this information to the Staff Member that will be in contact with you.

Instructions for Copy/Paste: 1. Open the document or email you wish to copy from 2. Left click and drag over all the text you wish to copy 3. Hold down the "control" key and push the "C" key, at the same time 4. Click in the box below, placing your cursor in the box 5. Hold down the "control" key and push the "V" key at the same time. Your information should appear in this boxed area. You may not be able to "see" all of the information, but it has copied.

Your signature below signifies that all information you have provided above is complete, true and accurate. It also signifies that you authorize our Staff Members to access any and all information necessary to conduct an investigation into this matter;

Thank you!
The Staff at Cyber Safety


All information submitted on this form is held in strict confidence
and will not be released under any circumstance.

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Date of Last Revision: Monday, June 02, 2008 at 11:03:37 PM
Footer Revised by: Aaron Forsman