2. 
4. Date of contact with Police Department Employee*
   Date of contact with Police Department Employee
5. Time
   Time
7. Location of Contact*
9. Employee’s name and serial number*
11. What initiated your contact with the employee?*

    1. Police response to your call
    2. Visit with a detective
    3. Made a report at the police station
    4. Traffic stop
    5. Pick up property
    6. Traffic Collision
    7. Witness at a police investigation
    8. Visit/release of a prisoner
    9. Other
13. What would you comment about the employee’s performance?*
15. Would you like to be contacted by a police supervisor?

    1. Yes
    2. No
17. First Name
18. Last Name
20. Address1
22. City
23. State
24. Zip
26. Email Address
27. Telephone Number
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field