Notice of Alleged Violation | Illinois Law Enforcement Training & Standards Board

General Information

Date/Time of Incident

Location of Incident

Alleged Violation

Did this activity involve any of the following (Check all that apply):

An act that would constitute a felony or misdemeanor which could serve as basis for automatic decertification, whether or not the law enforcement officer was criminally prosecuted, and whether or not the law enforcement officer’s employment was terminated

Exercised excessive use of force

Failure to comply with the officer’s duty to intervene, including through acts or omissions

Tampering with a dash camera or body-worn camera or data recorded by a dash camera or body-worn camera or directed another or tamper with or turn off a dash camera or body-worn camera or data recorded by a dash camera or body-worn camera for the purpose of concealing, destroying, or altering potential evidence

Engaging in the following conduct relating to the reporting, investigation, or prosecution of a crime: committed perjury, made a false statement, or knowingly tampered with or fabricated evidence

Engaging in any unprofessional, unethical, deceptive, or deleterious conduct or practice harmful to the public; such conduct or practice need not have resulted in actual injury to any person. As used in this paragraph, the term “unprofessional conduct” shall include any departure from, or failure to conform to, the minimal standards of acceptable and prevailing practice of an officer

None of the Above

Description of Incident

Was any person involved in the complaint, including a law enforcement officer, injured, in need of emergency medical care, hospitalized, or killed as a result of the incident?

Yes

No

Unknown

Please identify all evidence in your possession that is relevant to the incident, including, but not limited to, all time-sensitive evidence, audio and video evidence, physical evidence, arrest reports, photographic evidence, GPS records, computer data, lab reports, medical documents, and witness interviews. If you are aware of additional evidence that you do not have possession of, please include a description of this evidence and where it could be located. Please mail a copy of all evidence in your possession to "Attn: PTB Complaints, 500 South 9th Street, Springfield, IL 62701"

Type "Not Applicable" if there is no supporting evidence.

Complainant Information

I consent to have my identity disclosed

I do NOT consent to have my identity disclosed

First Name

Last Name

Agency (if applicable)

Age

Gender

Race/Ethnicity

Address

Address 2nd Line

City

State Abbreviation

Zip

Phone

Email

Other Agencies Notified

Witnesses

Were there any witnesses?

Yes

No

Certification of Truthfulness

The ILETSB take your complaints seriously, we ask you take them seriously as well. Please read the following items carefully.

I understand, and it is my desire, that this complaint be investigated diligently. I declare that the allegations contained in this complaint are true.
I also understand that it is a violation of 720 ILCS 5/26-1(a)(4) to willfully make a false report. In the event the report is proven to be false, the information may be provided to the State’s Attorney for possible prosecution.

I agree to the above

General Information

Officer Involved #

Alleged Violation

Complainant Information

Witnesses

Witness #

Certification of Truthfulness