Form Center

2. Online Complaint Form

   It is the policy of the City of Lebanon to encourage citizens to bring forward concerns regarding misconduct by City personnel and officials. The process for the filing of complaints and the investigation of those complaints is outlined in Policy ADM-126.1: Complaints & Investigations.
   
   Use this form to submit a complaint. Please provide as much detailed information as possible to aid in the investigation of your concerns.
   
   To submit an anonymous complaint, please use our Anonymous Complaint form hosted by Lighthouse or call 877-990-0006.
   
   The City will act on anonymous complaints according to Policy ADM-111: Anonymous Hotline Policy, however, we may be limited in our ability to investigate those concerns depending upon the information provided.
   
   Please be aware that complaints against the City Manager submitted via this form will be routed to outside legal counsel for review.

   
   

   Do not use this form to report crimes. Please call 911 or 603-448-1212 to report a crime.

6. Your Information
   This information will be used to contact you if necessary.
8. Last Name*
10. First Name*
11. Middle Initial
13. Street Address
15. City*
16. State*
17. Zip Code*
19. Email Address
21. Primary Phone
22. Alternate Phone
24. Voluntary Personal Information
    The following information is voluntary but helpful to know. If you do not wish to provide an answer, please choose "Decline".
26. Gender *

    1. Male
    2. Female
    3. Transgender Male
    4. Transgender Female
    5. Non-binary
    6. Other
    7. Decline
28. Racial/Ethnic Background *

    1. Asian
    2. Black/African American
    3. Hispanic/Latino
    4. Native American
    5. Pacific Islander
    6. White
    7. 2 or More
    8. Other
    9. Decline
32. Is this an informal or a formal complaint?*

    Please check if this is an informal (a complaint that is not of serious nature, is not a serious violation of department or city policies, is not believed to be serious by the citizen filing the complaint) OR a formal complaint (a complaint that in which the complainant indicated a desire to file a formal complaint against a City employee or City official. The department head or City Manager deem the complaint to be serious violation of City or department policy or would constitute a violation of law)?

    1. Informal Complaint
    2. Formal Complaint
34. Incident Information
    This information will be used to investigate the incident.
36. Date and Time of Incident
    Date and Time of Incident

    Date and Time of Incident
38. Location*
40. Name of City Employee or Official (Appointed or Elected)
    If more than one employee/official is being reported, please separate names with a comma.
42. Is any person listed above a City leader (i.e. director, manager, chief, etc.)?*

    1. No
    2. Yes
    3. I don't know
44. Is this complaint against the City Manager?*

    Complaints against the City Manager will be forwarded to outside legal counsel for review.

    1. Yes
    2. No
46. Department (if known)
    -- Select One --I don't knowAirportAssessingCity Clerk's OfficeCity Manager's OfficeCity Official (Appointed or Elected)FinanceFireHuman ResourcesHuman ServicesLibraryPlanning & DevelopmentPolicePublic WorksRecreation and Parks
48. Employee Department (if known)*
    -- Select One --I don't knowAirportAssessingCity Clerk's OfficeCity Manager's OfficeCity Official (Appointed or Elected)FinanceFireHuman ResourcesHuman ServicesLibraryPlanning and DevelopmentPolicePublic WorksRecreation and Parks
50. Name of Witness(es) or Others Involved (if applicable)
52. Witness Phone
54. Do you have photographs or video relevant to this incident?*

    1. Photos
    2. Video
    3. Both
    4. No
56. Statement/Description of Incident*
60. Truth and Accountability
    The City’s objective is to ensure critical services are provided to the citizens of the City in an unbiased and fair way. The City’s administration takes the complaint process seriously and will act on complaints filed in an expeditious manner. The complaint process is another key component to ensure the accountability of municipal government
62. Certification*

    1. I hereby certify that the information in this complaint is true and correct to the best of my knowledge and belief.
63. Signature*
    Please type your name above to provide your signature.
Leave This Blank:


65. 1. Receive an email copy of this form.
66. Email address

    This field is not part of the form submission.

67. Submit

* indicates a required field