Employee Misconduct Allegation (PD-92)

Employee Misconduct Allegation
PD-92 (09-2024)
Form Version
Date

MonthDayYear
Date
Hour Minutes
Status
FOR POLICE SUPERVISOR USE
unless a member is filing an allegation of misconduct by another member
(ref. BPDN 1.3.3 § 1.a.iv.)
1. Complete the online form
2. Submit the online form
3. View the confirmation page
4. Provide the complainant with the tracking number
5. If the complainant is present with you:
  1. download and print the PD-92 form
  2. have the complainant sign the PD-92 and forward original to P.S.D.
  3. provide the complainant with a copy of the PD-92

Complainant Information
Method of Reporting
"Website" is the selected method of reporting.

"Website" is only for use by the Professional Standards Division for complaints that are received through the public website.
Reference #*
from website entry - PSD use only
Electronic Signature Placeholder
Name

First NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email
Send the complainant a confirmation email
The above checkbox should remain checked unless there is good cause.
Delivery Email
Phone 1
Phone 2
Sex*
Race*
Ethnicity*

Receiving Member

RankFirst INITIALLast NameBadge #
The facts set forth herein are true and correct to the best of my knowledge, information, and belief. This verification is subject to the penalties set forth in 18 Pa.C.S. § 4904 relating to Unsworn Falsification to Authorities.
Receiving Member

Clear
Should be Empty:

Complainant Information