Internal Affairs | Report Form

Moderator: [LSEMS] Internal Affairs

Jasper Wuuuu
Posts: 438
Joined: Sat May 25, 2019 5:05 am

LSEMS Awards

Internal Affairs | Report Form

Fri Feb 21, 2020 7:28 am

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The following form is to be used when filing a complaint against a Los Santos Emergency Medical Services Employee(s).

If you feel you have been the victim of wrongful treatment or care from one of our medical professionals, we encourage you to fill out this form to the best of your ability. Each complaint is reviewed thoroughly by the Internal Affairs Division of the Los Santos Emergency Medical Services and when the investigation is complete, a ruling will be made as to whether the Department or its employees has violated current medical protocols and procedures or not. Please also note that we only take reports that have incidents within the last month ((1 week)).

Please provide any evidence of claims submitted. The Internal Affairs Division will conduct an investigation and do it's due diligence during the review, however, it is advised to provide as much evidence to help with the investigation.

(( Reports and evidence used can either be OOC or IC - We hold the LSEMS Faction to the highest of standards both OOC and IC and you may report a member for out of character reasons including but not limited to: ))
  • (( Poor Roleplay ))
  • (( Server Rule Violations ))
  • (( Negative OOC Attitude ))
  • (( Ignoring OOC faction rules ))
Reports and evidence are taken very seriously by the LSEMS Internal Affairs Division as we hold our medical professionals to the highest of standards.

You may report the LSEMS or one of its employees for reasons including but not limited to:
  • Medical Malpractice
  • Violation of Protocol and Procedures
  • Wrongful or Harmful treatment of a Patient
  • Disregard for Health or Life of an Individual
  • Improper Use, Sale, or Prescribing of Prescription drugs
Please e-mail the following complaint form to the Internal Affairs Division: INTERNAL AFFAIRS ((CLICK HERE))

Code: Select all

[img]https://i.imgur.com/OrQpxI3.png[/img]
[divbox=White]
[center][size=150][b]PERSONAL INFORMATION[/b][/size][/center]
[img]https://i.imgur.com/F7kU3dh.png[/img]

[b]Name:[/b] First Lastname
[b]Organization & Position (if applicable):[/b] Organization, Position
[b]Phone Number:[/b] ###-####
(([b] Eclipse RP Forum Name: [/b] Forum Name )) 
(([b] Discord: [/b] Discord here)) 
[/divbox]
[divbox=White]
[center][size=150][b]EMPLOYEE DETAILS[/b][/size][/center]
[img]https://i.imgur.com/F7kU3dh.png[/img]
[spoiler= Employee: First Last]
[b]Rank/Position:[/b]  [i][color=#0000FF]RESPONSE[/color][/i]
[b]Badge Number:[/b] [i][color=#0000FF]####[/color][/i]
[b]Employee Description if Name is Unknown:[/b]  [i][color=#0000FF]RESPONSE[/color][/i]
[/spoiler]

(Add additional employees if needed)
[/divbox]

[divbox=White]
[center][size=150][b]INCIDENT DETAILS[/b][/size][/center]
[img]https://i.imgur.com/F7kU3dh.png[/img]
[b]Location of Reported Incident:[/b] [i][color=#0000fF]RESPONSE[/color][/i]
[b]Approximate Date & Time of Reported Incident:[/b] [i]01/JAN/2018 - 00:00 UTC[/i]


[b]Detailed Description of Incident:[/b] [i][color=#0000FF]RESPONSE[/color][/i]


[b]Additional Information & Evidence:[/b] [i][color=#0000fF]RESPONSE[/color][/i]

[b](( OOC Evidence )):[/b] ((OOC Recordings, screenshots, chatlogs etc. ))
[/divbox]

[divbox=White]
[center][size=150][b]AGREEMENT[/b][/size][/center]
[img]https://i.imgur.com/F7kU3dh.png[/img]

[i]By filing in this report you hereby agree that all information and descriptions provided are truthful. 
You agree that all evidence provided to support your allegations are truthful and haven't been manipulated.

((By filing this you hereby agree that all OOC evidence used for OOC complaints are truthful and evidence has not been manipulated. 
You also agree that all information and evidence used in this form IC are entirely in character and have not been obtained OOC.))
(( [color=#0000BF]please note the form is fully IC unless stated otherwise[/color][/i] ))


[b]SIGNATURE:[/b] [i][font=Bradley Hand ITC] FIRST LASTNAME [/font][/i]

[/divbox]

[divbox=White]
[center][size=150][b]IA Use Only[/b][/size][/center]
[img]https://i.imgur.com/F7kU3dh.png[/img]

[spoiler=Rep Info]
Full name: [color=#0000FF]Fname Lname[/color]

Badge number: [color=#0000FF]####[/color]

Signature:  

Investigation Status = [color=#0000FF]Answer[/color]
[/spoiler]

[spoiler=1A][/spoiler]


[spoiler=2A If Applicable][/spoiler]


[spoiler=3A][/spoiler]


[spoiler= All Other Information][/spoiler]

[/divbox]
[img]https://i.imgur.com/46ZIqgd.png[/img]
Jasper Wuuuu
Posts: 438
Joined: Sat May 25, 2019 5:05 am

LSEMS Awards

Re: Internal Affairs | Report Form

Fri Feb 21, 2020 7:31 am

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PERSONAL INFORMATION
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Name: First Lastname
Organization & Position (if applicable): Organization, Position
Phone Number: ###-####
(( Eclipse RP Forum Name: Forum Name ))
(( Discord: Discord here))
EMPLOYEE DETAILS
Image
Employee: First LastShow
Rank/Position: RESPONSE
Badge Number: ####
Employee Description if Name is Unknown: RESPONSE
(Add additional employees if needed)
INCIDENT DETAILS
Image
Location of Reported Incident: RESPONSE
Approximate Date & Time of Reported Incident: 01/JAN/2018 - 00:00 UTC


Detailed Description of Incident: RESPONSE


Additional Information & Evidence: RESPONSE

(( OOC Evidence )): ((OOC Recordings, screenshots, chatlogs etc. ))
AGREEMENT
Image

By filing in this report you hereby agree that all information and descriptions provided are truthful.
You agree that all evidence provided to support your allegations are truthful and haven't been manipulated.

((By filing this you hereby agree that all OOC evidence used for OOC complaints are truthful and evidence has not been manipulated.
You also agree that all information and evidence used in this form IC are entirely in character and have not been obtained OOC.))
(( please note the form is fully IC unless stated otherwise
))

SIGNATURE: FIRST LASTNAME
IA Use Only
Image
Rep InfoShow
Full name: Fname Lname

Badge number: ####

Signature:

Investigation Status = Answer
1AShow
2A If ApplicableShow
3AShow
All Other InformationShow
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