Nashville.gov

• How To Make a Complaint

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Office of Professional Accountability Complaint Form

** Please note that all of the fields below except "Witnesses" are required. **
If you do not have any information to provide in a field, you may type N/A.

Complainant Information

Name
Home Address
City, State, Zip
Business Address
City, State, Zip
Home Telephone
Cellular Telephone
Pager Number
Business Telephone

Witness Information

You may submit up to three witnesses in the fields below. If you have additional witnesses, you may add those in the incident description area.

Witness #1 Name
Address
City, State, Zip

Witness #2 Name
Address
City, State, Zip

Name
Address
City, State, Zip

Incident Information

Description of incident (include date and location)