Complaint Form for EMS, Fire or Medical Transportation

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 type the answer to the question.