2. Big Spring Fire Department
4. Emergency Medical Service Complaint Form
6. Please complete and submit this form. You may also mail this form to Big Spring Fire in a sealed envelope addressed to BSFD, 1401 Apron Dr, Big Spring, TX 79720. If you do not know the information for a particular blank, please leave it empty. You may be contacted at a later date for additional information.
10. Complainant Information
12. Name
13. Email Address
15. Address
17. City
18. State
19. Zip Code
21. Phone Number
22. Fax Number
24. Secondary Phone Number
28. Incident Information:
30. Date and Time
    Date and Time

    Date and Time
32. Address
34. City
35. State
36. Zip Code
38. Reason for Employee Contact:
40. Nature of Complaint:
42. Remedy Sought
46. Employee Information
48. Last Name
49. First Name
51. Title / Rank
52. Race
53. Gender:
55. Other Involved Employee:
57. Other Involved Employee
61. Whitness Information
63. Witness #1
65. Name
66. Email Address
68. Address
70. City
71. State
72. Zip Code
74. Phone Number
75. Fax Number
77. Secondary Phone #
79. Whitness #2
81. Name
82. Email Address
84. Address
86. City
87. State
88. Zip Code
90. Phone Number
91. Fax Number
93. Secondary Phone #
95. Witness #3
97. Name
98. Email Address
100. Address
102. City
103. State
104. Zip Code
106. Phone Number
107. Fax Number
109. Secondary Phone #
113. Complainant Statement
     INSTRUCTIONS: Please describe below in detail the incident about which you wish to complain. Be specific about persons involved and their actions. Use as many pages of the statement form as needed and remember to sign and date the last page.
115. Statement:
117. Complaint Made By
     NOTE: Complainants signing this government document are swearing and attesting that the information contained herein is true and accurate.
119. First Name
120. Last Name
122. Date
     Date
Leave This Blank:


124. 1. Receive an email copy of this form.
125. Email address

     This field is not part of the form submission.

126. Submit Submit and Print

* indicates a required field