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TIP FORM

 The information recorded in this form is for information purposes only. In case of an emergency, please  dial 911 immediately.

 Please review the activity type checkboxes below. If your Tip information is not associated with either of  these categories, please consider contacting the following resources for assistance:

 • Office of the Ombudsman djjombudsman@djj.state.ga.us or by calling toll-free 1-855-396-2978.
 • Generating an Special Incident Report (DJJ Policy 8.5) for allegations of Employee Misconduct.
 • Filling an Employee Grievance for any supervisory related matters (as outlined in DJJ Policy 3.23).
   By notifying the office of Human Resources (Employee Relations Unit) for any FLSA or work hour
   related concerns by calling (404) 508-7256 haroldcooper@djj.state.ga.us or (404) 508-6646 or
   chrisjones@djj.state.ga.us



Date & Time: 
 
  Type of Activity:
 
 
 
 



  Information Submitted By:
 Last Name:
 First Name:
 Facility Assigned:
 Street Address:
 City:
 State:
 Zip:
 Phone: (XXX-XXX-XXXX)
 Email:
 May we contact you?:
  Information Concerning:
 Please Choose Concerning:
 Last Name:
 First Name:
 Alias 1:
 Alias 2:
 Gang / Organization:
 DOB: (MM/DD/YYYY)
 Sex:
 Race:
 Street Address:
 City:
 State:
 Zip:
 Facility Assigned:
 Date/Time Of Occurrence: (MM/DD/YYYY HH:MM:SS)
  *Details (below describe the details of what happen to include the date, time, behavior, location, and any   additional names):
(Character Limit = 500)  
 
   
 
   
 

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