Date (Select this checkbox to input a date range )* Dates cannot be after today's date.
Start date must be before end date. Location where incident occurred*:
How did you become aware of this incident?*
What is your relationship to LADBS (ie: customer, contractor)*
Please identify the person(s) engaged in this behavior: First Name, Last Name *
Please provide all details regarding the alleged incident, including the location of witnesses and any other information that would assist in the evaluation and resolution of this incident. Please provide as much detail as possible. *

Do not intentionally include false or misleading information in your complaint. The intentional reporting of false or misleading information may result in civil or criminal liability.