North Ridgeville Fire Department Complaint Form

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Complaint Form
North Ridgeville Fire Department: EMS, Fire, or Medical Transportation Complaint Form

Notice to Complainant:
All complaints against an EMS Provider, Fire Safety Inspector, Fire Educator, Administrative Assistant, Dispatcher, Firefighter, or Fire Officer will be thoroughly investigated by the North Ridgeville Fire Department. Complaints can be filed anonymously. Please note that the North Ridgeville Fire Department cannot provide a response to you regarding disposition of your complaint without contact information.

Name:

Address:

Phone Number:

Email Address:

Date of Complaint:

Name, Rank, or Description of Complaint is Against (if known)

Description of Complaint (describe event, conduct, behavior or circumstances that you believe to be improper. Please provide as much detail as possible, to include, but not limited to date, time, location):

Witness #1 Name:

Witness #1 Address:

Witness #1 Telephone Number:

Witness #2 Name:

Witness #2 Address:

Witness #2 Telephone Number:

Witness #3 Name:

Witness #3 Address:

Witness #3 Telephone Number:

What Remedy Are You Seeking?

To validate your submission, please answer the following math problem: