Required fields are marked with asterisks (*)

Complaint Report

IF THIS IS AN EMERGENCY PLEASE CALL 911

Complainant Information

First Name

Last Name

Address

Town/Hamlet/Subdivision

Postal Code

Primary Phone Number

Secondary Phone Number

Other Witness

Additional Witness First Name

Additional Witness Last Name

Additional WItness Phone Number

Additional Witness Address

Add Witness Remove Witness

Details of Offence

Date of Offence

Time of Offence

Location of offence (Ex. House number/street number/subdivision/hamlet/town/RGE RD/TWP RD...)

Describe the offence (5000 Characters Max)

Would you like a follow-up call once the investigation is complete?

Yes

Protection of Privacy - Personal information collected on this form will be used for the purpose of administering the program or service which the information is collected. This collection is authorized by Section 4(c) of the Protection of Privacy Act and the information collected will also be subject to the Access to Information Act. For questions about this collection of personal information by the County of Grande Prairie, contact the Access and Privacy Officer at AccessPrivacy@countygp.ab.ca or call 780-532-9722.