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COUNTY OF BERGEN
OFFICE OF THE INSPECTOR GENERAL

ONE BERGEN COUNTY PLAZA, ROOM 580, HACKENSACK, NJ 07601-7076
Phone: (201) 336-6975 Fax: (201) 336-6966
INTAKE FORM
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Detailed description of the complaint. Include:
Who committed the alleged misconduct/wrongdoing? Include their full name, title/position, and relation to you (the complainant).
What the individual did that was wrong and or how the misconduct/wrongdoing was committed?
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When did the misconduct or wrongdoing occur?
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Do you know of efforts made thus far to correct the problem and/or the current status of the problem?
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Has this complaint been directed to anyone else in addition to the Office of the Inspector General?
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Where can we obtain additional information concerning this misconduct/wrongdoing (such as supporting documentation)? Additionally, who else might be aware of this misconduct/wrongdoing? Please specify their relation to the alleged problem.
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