HomeMy WebLinkAboutComplaint FormComplaint No. HCFC:
HAWAI`I COUNTY FIRE COMMISSION
Aupuni Center, 101 Pauahi Street, Suite 9, Hilo, Hawaii 96720
Phone: (808) 932-2950 Fax: (808) 932-2949
Date Received:
COMPLAINT OF MISCONDUCT BROUGHT BY THE PUBLIC
Pursuant to Fire Commission Rule 8(A), a complaint against the conduct of the department or any of its
members or employees while on duty or acting under the color of authority shall be in writing, signed
and dated by the complaint under oath before a Notary Public. This notarized complaint must be received
by the Commission's office not more than 90 days from the date of the incident. A request for consideration
for an exception to this rule must be in writing with an explanation for the delay. A complaint form or letter
signed, dated, and notarized by the complainant's immediate family shall be accepted as a complaint if the
victim is deceased.
PLEASE TYPE OR PRINT
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Mailing Address:
Date of Incident:
Birth Date: SS# last 4 digits:
Time: Location:
ACCUSED: (Name or description if unknown
Name:
Name:
Phone:
SUMMARY OF COMPLAINT. List the complaint classification # as listed on the back of this form, then
summarize the incident of misconduct as it pertains to the classification #.
Name and address of physician seen for injuries:
(Fill out HCFCFORM-2)
I would like to have my complaint reviewed in a meeting open closed to the public.
HCFCFORM-1 Rev. 7-18-22 Page 1 (Turn page over to notarize complaint.)
Hawai `i County is an Equal Opportunity Provider and Employer
I have prepared the foregoing Complaint of Misconduct Brought by the Public and hereby certify
that, to the best of my knowledge, and under penalty of perjury, the statements herein are true.
I understand that the County Charter only permits the Hawai'i County Fire Commission to hear
complaints by the public, and make recommendations to the Fire Chief. In addition, I understand that the
Fire Commission is not permitted to interfere in the administrative affairs of the Fire Department.
I further understand that the rules of the Hawai'i County Fire Commission, as well as Hawai'i
Revised Statutes, Chapter 92F, also know as the Privacy Act, prohibit the unauthorized release of
confidential records by the Fire Commission, except as permitted by law or a court of competent jurisdiction.
STATE OF HAWAI'I
Complaint's Signature COUNTY OF HAWAI'I
Parent or Guardian's Signature
if complainant is a juvenile.
Subscribed and sworn to before me this
day of
Notary Public, State of Hawai'i
Printed name of Notary Public
Judicial Circuit
My commission expires:
20
COMPLAINT CLASSIFICATIONS
1. Standard of Conduct — Members shall conduct their lives in such a manner as to avoid bringing
themselves or the department into disrepute.
2. Performance of Duty — Members shall perform their duties as required or directed by law, departmental
procedures, policies, or orders of a command or supervisory officer. All lawful duties shall be performed
promptly notwithstanding the general assignment of duties and responsibilities.
3. Obedience to Laws, Written Orders, and Policies — Members of the department shall observe and
obey all federal and state laws, ordinances of the County of Hawai'i, and all orders, policies, and
regulations of the department.
4. Commission of any Criminal Act — Members shall not commit any criminal act. For the purpose of
this section, it is not required that the member be convicted of a crime. Acceptance of immunity from
criminal prosecution, deferred acceptance of guilty pleas, deferred prosecution, and other such
dispositions shall be considered prima facie evidence that a criminal act was committed.
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