Jefferson County 9-1-1 encourages you to reach out if you have a complaint or would like to share a positive experience that involves 9-1-1 services and impacts you as a citizen. We kindly ask that you complete this form as soon as possible, ideally immediately after the incident or issue occurs. A representative from Jefferson County 9-1-1 will contact you within twenty-four (24) business hours.

Please note that, if necessary, your identity and/or complaint details may need to be disclosed to facilitate a formal investigation. Any such disclosures will only be made to individuals who have a legitimate need to know the details of your complaint

Have you ever had to call Jefferson County 9-1-1?

Yes

No

Which service did you need?

Sheriff's Deputy

Fire Department

If you choose Fire Department, Which Fire Department ?Choose FD'sAdger FDAntioch FDBagley FDBirmingport FDBrighton FDBrookside FDCane Creek FDCenter Point FDConcord FDCorner FDEastern Valley FDFairfield FDForestdale FDFultondale FDGlennwood FDGraysville FDKimberly FDLipscomb FDMaytown FDMcCalla FDMcAdory FDMinor FDMorris FDMt. Olive FDMulga FDNorth Smithfield FDNorth Johns FDPalmerdale FDRocky Ridge FDShady Grove FDSylvan Springs FDTrafford FDTrussville FDWarrior FDWarrior River FDWest Jefferson FD

Was it to...

Report a crime

Report a fire

Report an accident

Other

How would you rate the telecommunicator / Dispatcher you spoke with?

Understanding and helpful

Understanding or helpful

Nice

Rude

Do you feel that your call was answered in a timely manner?

Yes

No

Were you provided with any pre arrival instructions (medical incidents only)

Yes

No

---

Personal Information

First Name

Last Name

Today's date

Phone Number

Incident Number / Case Number

Date of Incident

Time of Incident

---

Location Information

Building Number

Full Street Name

City Name

Zip Code

Nature of complaint Note all relevant dates, places, events, etc. pertaining to this complaint:

---

I acknowledge that I have read this document and understand my obligation to provide information as needed and to cooperate fully and completely with any investigation of this complaint. Should it become necessary, I authorize Jefferson County 9-1-1 to disclose my identity and/or details of this complaint.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

There was a problem saving your submission. Please try again later.

Please wait while your submission is being saved...

Submitting...Submit

Thank you, your submission has been received.