Thank You for Your Submission

2. This form is used to report allegations of misconduct by a police officer, 911 dispatcher, office staff or other member of the Champlin Police Department.  

   The Champlin Police Department takes complaints against any staff member very seriously. The Champlin Police Department accepts and documents all complaints and investigates them where warranted. If you provide contact information, you will be notified if an investigation into the allegation is warranted and the findings when the investigation is complete.

   You are not required to provide contact information, and there are no penalties for leaving these fields blank. However, declining to provide information may affect the investigation of the complaint. Please note that intentionally providing false information could subject you to criminal or civil consequences.

4. Contact Information for Person Making the Complaint

6. First Name
7. Last Name
9. Phone Number
10. Email Address
12. Address
14. City
15. State
16. Zip Code
20. Officer or Staff Name (if known)
21. Badge Number (if known)
23. Does your commendation involve more than one officer or staff member?
25. Date and Time
    Date and Time

    Date and Time
26. Location of Event
28. Details
30. Witness Name
31. Witness Phone Number
32. Witness Email
34. Do you have a document to upload that is related to this event?
35. Additional photos or documents related to this event?
39. Electronic Signature Agreement

    Public Data Advisory*

    The information you are being asked to provide is classified as “public," “private” and “confidential” pursuant to the Minnesota Government Data Practices Act. The purpose of collecting this information is to appropriately investigate your complaint. You are not required to supply the requested information, but not doing so will hinder the investigation of your complaint. The information you provide can be accessed by others in accordance with the Data Practices Act.

    Your information will be used as part of the total evidence to determine if misconduct occurred and, if so, whether any disciplinary or corrective action should be taken. Your information may be used in meetings, hearings or procedures such as grievance hearings, an arbitration process or other appeal procedures, and you may be required to testify.

    The following individuals and entities may have access to the information you provide:

    • Employees and officials of the City of Champlin whose work assignments reasonably require access to the information
    • Other persons or entities authorized by a state or federal law, or by court order, to have access to such information
    • If disciplinary action is taken based on the results of this investigation, the information you provide may be available to others and the public as documentation supporting final disciplinary action
    • The subject(s) of the data
    • Management/administrators/supervisors whose input may be necessary for the decision-making process; exclusive representatives; employees of the Minnesota Department of Employee Relations; arbitrators; state and federal courts; state and federal human rights enforcement entities; appropriate licensing entities and agencies; the Re-employment Compensation Division of the Department of Economic Security; law enforcement agencies and prosecutorial authorities; transcription services; individuals or entities with contracts providing access to the data; and counsel for parties to litigation pursuant to a court order

    Please be advised that Minnesota law (Minnesota Statute 609.505) makes it a criminal offense to make a knowingly false and defamatory report of police officer misconduct.

    1. I have read and understand the Public Data Advisory.
41. Electronic Signature
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field