Civil Rights Unit

Civil Rights Unit

Case Review Request Form
Current Date

MonthDayYear
Please provide as much information as you can in order for us to be able to investigate the incident. The more detail you provide, the more likely we will be able to follow up on the matter.

Our goal is to review complaints filed to determine whether any criminal charges may be appropriate. We have no authority over other disciplinary actions that may be taken against an officer.
Reporting Person’s Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Primary Language

EnglishSpanishOther
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Alternate Phone Number
Email
Are you currently represented by an attorney?

YesNo
Attorney Name
Attorney Contact Information
Phone Number / Email Address
Incident Information
Incident Date & Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Do you know the exact incident location?

YesNo
Incident Address

Street Address

Street Address Line 2

CityState

Zip Code
Please try to describe the location. This may lead to possible surveillance video:
Police Agency

Austin PoliceDPSOther
Can you provide any video, audio or photos?

YesNo
Please attach any video, audio or photos:

Cancelof
Are there any videos posted online?

YesNo
Please share a link to the video:
Have you reported this incident to or filed a complaint with:
1. The law enforcement agency involved?

YesNo
2. The Office of Police Oversight?

YesNo
NOTE: This will not keep us from investigating, but it is helpful to know if another agency is already aware of the incident.
Describe in detail what you observed:
Injuries Observed
Was anyone injured?

YesNo
Please describe the injury:
Were they treated by EMS?

YesNo
Were they taken to a medical facility?

YesNo
Which medical facility?
Is the injured person different from the reporting person?

YesNo

Injured Person
Injured Person
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Primary Language

EnglishSpanishOther
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Alternate Phone Number
Email
Officers' Information
Do you know the officers' information?

YesNo

Officer 1
Officer 1
Name 1

First NameLast Name
Badge Number 1
Add another officer?

YesNo

Officer 2
Officer 2
Name 2

First NameLast Name
Badge Number 2
Add another officer?

YesNo

Officer 3
Officer 3
Name 3

First NameLast Name
Badge Number 3

End
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Should be Empty:

Civil Rights Unit

Reporting Person’s Information

Incident Information

Injuries Observed

Injured Person

Officers' Information

Officer 1

Officer 2

Officer 3