Department of Juvenile Justice Department of Juvenile Justice
 

 



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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 a complaint regarding any supervisory related matters, you may complete a complaint form,
    as outlined in DJJ Policy 3.32, and submit via email to the Office of Human Resources,
    Employee Relations unit at djjhr.employeerelations@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: (XXXX@DJJ.STATE.GA.US)
 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)