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Traffic Complaint
This form is used to report a traffic complaint in your area
Incident Narrative
Describe your incident here, and please be as detailed as possible.
Incident Narrative
(required)
Incident Location Information
Please provide location information related to the incident.
Incident Location
(required)
Please provide date and time information for which the incident occurred.
Beginning Timeframe
(required)
Ending Timeframe
(required)
Reporting Person Information
Please enter your information.
First Name
(required)
Middle Name
Last Name
(required)
Date of Birth
(required)
Racial/Ethnic Identity
Asian
Black, African, or African American
Hawaiian or Pacific Islander
Hispanic, Latino/a/x, or Caribbean
Middle-Easterner or Arab
Multiracial or Mixed
Native American or Indigenous
White or Caucasian
Another
I decline to answer this question
Gender/Gender Identity
Male
Female
Another Gender Identity
I decline to answer this question
Phone Number
(required)
Email Address
(required)
Confirm Email Address
(required)
Home Address
(required)
Zip Code
(required)
Driver's License Number
Driver's License State
If you are reporting on behalf of someone else, please click Add Additional below and include the victim's information.
+ Add Additional : Reporting Person Information
Contact Information
Please provide the best e-mail and phone number to reach you.
E-Mail Address
(required)
Mobile Phone Number
(required)
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(required)
No Appointment
Schedule Contact Appointment
Please pick an available date and time for an officer to contact you via Phone or Zoom.
Filing a false police report is a crime (ORS 162.375). Please review your information above.
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400 E Main St
Cottage Grove, OR 97424
Phone: (541) 942-9145
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