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2. 
   Franklin County Department of Public Safety
   50 Claiborne Ave.
   Rocky Mount, VA 24151
   540-483-3091

   

4. This form may be used to make formal commendations or complaints about the service provided by Franklin County Department of Public Safety.
6. Choose One*

   1. Commendation
   2. Complaint
8. Name
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Email Address
18. Date and Time of Incident
    Date and Time of Incident

    Date and Time of Incident
19. Location/Address of Incident
21. Name (s) of FCDPS Employee/Volunteer (if known)
23. Description of Incident*
25. Signature*
26. Date Form Submitted
    Date Form Submitted
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28. 1. Receive an email copy of this form.
29. Email address

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