If you believe you've received inappropriate treatment or care from one of our medical professionals, we urge you to complete this form thoroughly. Each complaint is carefully reviewed by our Internal Affairs Division, and upon completion of the investigation, a ruling will determine if any violations of medical protocols or procedures have occurred. Please note that we only accept reports for incidents within the last 14 days.
Please provide any evidence of claims submitted. The Internal Affairs Division will conduct an investigation and do its 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 ))
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
Sample Report
PERSONAL INFORMATION
Name: First Lastname
Organization & Position (if applicable): Organization, Position
Phone Number: ###-####
(( Discord: Discord here))
EMPLOYEE DETAILS
Employee#1
Name: Fname Lname
Rank/Position: RESPONSE
Badge Number: ####
Employee Description if Name is Unknown: RESPONSE
Employee#2
Name: Fname Lname
Rank/Position: RESPONSE
Badge Number: ####
Employee Description if Name is Unknown: RESPONSE
*Add additional employees to the list of needed
INCIDENT DETAILS
Location of Reported Incident: RESPONSE
Approximate Date & Time of Reported Incident: DD/MMM/YYYY - HH:MM UTC
Detailed Description of Incident: RESPONSE (Detail is needed here)
Additional Information & Evidence: RESPONSE
(( OOC Evidence )): ((OOC Recordings, screenshots, chatlogs etc. ))
AGREEMENT
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 is truthful and hasn'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
Copy this code
Code: Select all
[img]https://i.imgur.com/qaxAEJB.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] Discord: [/b] Discord here))
[/divbox]
[divbox=White]
[center][size=150][b]EMPLOYEE DETAILS[/b][/size][/center]
[img]https://i.imgur.com/F7kU3dh.png[/img]
[u]Employee#1[/u]
[b]Name:[/b] Fname Lname
[b]Rank/Position:[/b] RESPONSE
[b]Badge Number:[/b] ####
[b]Employee Description if Name is Unknown:[/b] RESPONSE
[u]Employee#2[/u]
[b]Name:[/b] Fname Lname
[b]Rank/Position:[/b] RESPONSE
[b]Badge Number:[/b] ####
[b]Employee Description if Name is Unknown:[/b] [i]RESPONSE[/i]
*[i]Add additional employees to the list of needed[/i]
[/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] RESPONSE
[b]Approximate Date & Time of Reported Incident:[/b] DD/MMM/YYYY - HH:MM UTC
[b]Detailed Description of Incident:[/b] RESPONSE (Detail is needed here)
[b]Additional Information & Evidence:[/b] RESPONSE
[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 is truthful and hasn'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]
[LSEMSfooter][/LSEMSfooter]Please submit the complaint form here.