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NBPC Complaint Form (09/19) 1 of 6
Complaint FormHow to complete the form:• You may type your request or use a pen. Please do not use a pencil.• Be sure to complete all sections of the form.• Contact the New Brunswick Police Commission (NBPC), police force
or civic authority (see appendix) if you need help completing the form.
Section A: Your information (you are the Complainant)
First name Last name
Date of birth (YYYY-MM-DD)
Physical address
Mailing address (if different from physical address)
E-Mail address
Phone number
Preferred language of communication Preferred method of correspondence
English French Mail E-mail
Only complete this portion if you are filing this complaint on behalf of someone else.
First name Last name
Your relationship to the complainant
Parent/Legal Guardian Power of Attorney Legal Representative
Mailing address
E-Mail address
Phone number
To ask the NBPC to consider your complaint for processing, you will need to:
• answer the following questions; and• submit any documents (including photos and videos) that support your allegations.
12422
For office use onlyDate filed
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Section B: Subject of the complaint (they are the Respondent(s))
1. Police Force Bathurst Police Force B.N.P.P. Regional Police Edmundston Police Force Fredericton Police Force Grand Falls Police Force
Kennebecasis Regional Police Force Miramichi Police Force Saint John Police Force Woodstock Police Force
NOTE: The NBPC does not have jurisdiction for complaints involving members of the RCMP. Please contact the Civilian Review and Complaints Commission for the RCMP at 1-800-665-6878 or www.crcc-ccetp.gc.ca for in-formation on how to file a complaint against a member of the RCMP.
2. Police Officer(s) (if applicable)
a. Officer name(s):
b. If name is not known, provide information to assist in identifying the officer (for example: badge number, physical description, car number, etc.).
Section C: Details of the incident
Date of the incident* (YYYY-MM-DD) Time of the incident
Location of the incident (ex. Address, intersection, street, etc.)
* Note: If your complaint is beyond the one-year time limit for making a complaint, the Commission may extend the time limit based on certain criteria. Please contact the NBPC for further information or refer to the Commission’s Guideline on time limit extension for making a complaint on our website at https://nbpolicecommission.ca/.
NBPC Complaint Form (09/19) 3 of 6
1. Briefly describe what happened in chronological order.Note: If you are filing a complaint against a police officer (Respondent), describe the officer’s behaviour toward you. If you are filing a complaint regarding a police force’s service or about a police force policy, describe the service you did or did not receive, or how the service was an issue for you. How did this have an impact on you?
You must identify what specific act or omission (what was done, said, or not done) by the Respondent(s).
NBPC Complaint Form (09/19) 4 of 6
2. Were there any witnesses? If so, provide names and contact information (if known).Note: This includes other police officers.
3. Are you or were you involved in another proceeding or process (for example: criminal charges, a union grievance, Human Rights complaint, an arbitration, civil action, etc.) dealing with the same incident(s) described in your complaint?
No: Please proceed to question 4. Yes: Please answer the questions 3a and 3b.
a. Has this proceeding or process ended? Yes: When did it end? No
b. What kind of proceeding/process is/was it?
4. Supporting informationDo you have any documentation supporting your allegations?
No, please proceed to question 5. Yes, please answer question 4a.
a. If yes, the information must be forwarded to the NBPC, chief of police, or civic authority. Identify the information you will be sending (for example: medical report, court transcript/recording, photograph, video, etc.).
5. InjuriesDid you sustain any injuries during the incident?
No, please proceed to section D. Yes, please answer question 5a.
a. If yes, describe your injuries and the medical treatment received.
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Section D: ResolutionThe main goal of complaint resolution is to provide complainants and police officers an opportunity to engage in a process where they can share their perspectives and find common ground with the aim of coming to a resolution agreement between both parties.
1. What do you think would be an appropriate resolution to this matter?
2. Informal resolution/mediationI would consider participating in an informal resolution process or mediation for this matter if my complaint is accepted.
Yes No
Section E: Please read and initial each of the statements below.
Statement Initials1. I declare the information I have provided in this form is true to the best of my
knowledge and belief. 2. I understand that the Commission/Chief/Civic Authority (as applicable) will send a copy
of this complaint and any supporting documentation* to the Respondent(s). 3. I understand that if this complaint is investigated my cooperation is required and that
failure to do so may result in my complaint being concluded and I cannot re-file my complaint.
4. I understand that I must provide the Commission/Chief/Civic Authority (as applicable) with any changes to my contact information and respond when contacted otherwise my complaint may be closed as having been abandoned.
*Unless doing so would be contrary to subsection 29(1) of the New Brunswick Right to Information and Protection of Privacy Act (disclosure harmful to law enforcement or legal proceedings).
Complainant’s signature (Typing your name in this section serves as signature)
Date
Submit your completed form to the NBPC, police force or civic authority (board, joint board or city council). See the appendix for contact information.
The personal information provided on this form is collected in accordance with paragraph 37(2)(a) of New Brunswick’s Right to Information and Protection of Privacy Act for purposes of responding to your complaint under the Police Act.
For office use only
NBPC file number When was the complaint form filed? What is the start date for the alleged period of the violation?
Comments
NBPC Complaint Form (09/19) 6 of 6
New Brunswick Police Commission435 King Street, Suite 202Fredericton, NB E3B 1E5Telephone: (506) 453-2069
E-mail: [email protected]: (506) 457-3542
Police Force Civic Authority
Bathurst Police ForceChief Ernie Boudreau285 King AvenueBathurst, NB E2A 1N9Telephone: (506) 548-0420E-mail: [email protected]
City of BathurstMr. Paolo Fongemie, Mayor150 St. George StreetBathurst, NB E2A 1B5Telephone: (506) 548-0400E-mail: [email protected]
B.N.P.P. Regional Police ForceChief Charles Comeau398 PrincipaleNigadoo, NB E8K 3M8Telephone: (506) 542-2666Email: [email protected]
Comité mixte des services de la police BNPPNormand Doiron, Président398, rue PrincipaleNigadoo, N.-B. E8K 3M8Telephone: (506) 542-2626
Edmundston Police ForceChief Alain Lang15, rue de l’Église, suite 101Edmundston, NB E3V 1J3Telephone: (506) 739-2100E-mail: [email protected]
City of EdmundstonCyrille Simard, Mayor7 Canada RoadEdmundston, NB E3V 1T7Telephone:(506) 739-2115E-mail : [email protected]
Fredericton Police ForceChief Roger Brown311 Queen StreetFredericton, NB E3B 1B1Telephone: (506) 460-2300Fax: (506) 460-2316
City of FrederictonChris MacPherson, CAO397 Queen StreetFredericton, NB E3B 1B5Tel: (506) 460-2020E-mail: [email protected]
Grand Falls Police ForceChief Suzanne Themens131 Pleasant StreetGrand Falls, NB E3Z 1G6Telephone: (506) 475-7767E-mail: [email protected]
Town of Grand FallsMarcel Deschênes, Mayor131 Pleasant Street, Suite 200Grand Falls, NB E3Z 1G6Telephone: (506) 475-7777E-mail: [email protected]
Kennebecasis Regional Police ForceChief Wayne Gallant126 Millennium DriveQuispamsis, NB E2E 6E6Main line: (506) 847-6300E-mail: [email protected]
Kennebecasis Regional Joint Board of Police CommissionersBob McLaughlin, Chair126 Millennium DriveQuispamsis, NB E2E 6E6
Miramichi Police ForceChief Paul Fiander1820 Water StreetMiramichi, NB E1N 1B7Telephone: (506) 623-2125E-mail: [email protected]
City of MiramichiMichael Noel, City Manager141 Henry StreetMiramichi, NB E1V 2N5Telephone: (506)623-2205E-mail: [email protected]
Saint John Police ForceChief Bruce ConnellP.O. Box 1971Saint John, NB E2L 4L1Telephone: (506) 648-3200E-mail: [email protected]
Saint John Board of Police CommissionersEdward Keyes, ChairP.O. Box 1971Saint John, NB E2L 4L1Telephone: (506) 648-3324E-mail: [email protected]
Woodstock Police ForceChief Gary Forward822 Main StreetWoodstock, NB E7M 2E8Telephone: (506) 325-4601E-mail: [email protected]
Town of WoodstockKen Anthony, CAO824 Main StreetWoodstock, NB E7M 2E8Phone: (506) 325-4600E-mail: [email protected]
