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Washoe County Department of Juvenile Services

COMPLAINT FORM

Name of Person Completing Form

Phone and Email

Phone Number

Email Address

Name of employee(s) against whom complaint is being made:

Date and Time of Incident

Location of Incident

Were there any witnesses to the incident?

Yes

If so, please provide their names and contact information.

Description of the conduct that occurred, including all relevant information:

Would you like to be contacted regarding he status of your compliant? If so, please make sure to fill out the contact information above.