Complaint Form

Complaint Form

Making a Complaint

Please Note: We take allegations of employee misconduct very seriously. Please be as accurate and factual as possible when making a complaint.

If you feel a Bedford County EMS staff member has acted improperly, a complaint may be made in writing, in person, by email or by telephone.

Complaints are categorized as:


A complaint prompting a preliminary investigation to determine if the complaint has possible merit. If the Informal Complaint is determined to have merit, the complaint will then be followed up on by administrative staff for corrective action. Informal Complaints may be upgraded to a Formal Complaint process if the severity of the complaint dictates such a need. Informal Complaints can be emailed to administration.


Your Complaint Form is completed and forwarded to the EMS Director and/or EMS Administrative Supervisor. An Administrative Investigation Referral Form is then completed by the EMS Director or EMS Administrative Supervisor and a preliminary investigation is conducted to determine if the complaint has possible merit. If merit exists, the investigation is expanded.

Formal complaints must be filed by completing a Complaint Form either electronically via form below, email or by forwarding it to the address listed below.

Bedford County EMS
Attn: Complaint Process
119 Frank Martin Road
Shelbyville, TN 37160

Complainant Information

Incident Information

Reason for Employee Contact

Employee Information

Witness Information

Complaint 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 initial each page and sign and date the last page. Typed statements on separate pages will be accepted if signed and dated.

NOTE: Complainants signing this government document are swearing and attesting that the information contained herein is true and accurate.

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