CottageGrove Fire/EMS Department
COMMENDATIONREPORT
Cottage Grove Public Safety collectively serves our community
compassionately providing protection of life and property.
We do this with honor, integrity, pride and professionalism.
We are Cottage Grove Public Safety.
Commendations
The Cottage Grove Fire/EMS Department is committed to maintaining integrity, discipline,
and a relationship with the community
of
trust and
con
f
ide
n
ce
.
We
welcome
citizen’s
recognition
of
fire/ems
e
m
p
loy
ee
s
performing in an effective, quality manner. If you have
had a positive experience involving one of our employees and you believe the employee
should be recognized for their performance, please take the time to fill out the form below.
When you have completed the Commendation form, either bring it to the Public Safety
Department, Monday through Friday, 7:00 a.m. to 4:30 p.m. or mail it to:
Director of Public Safety
Cottage Grove Public Safety Department
12800 Ravine Parkway
Cottage Grove, MN, 55016
Please complete this form as fully and accurately as you are able. When describing the incident,
write down a detailed account as you remember it. Whenever possible, include the location, date,
time, and telephone number, and the names and addresses of other known witnesses. If
known, give the name(s) of the fire/ems staff involved.
If
you do not know the staff
s
name(s),
use t
h
e
narrative section to describe the staff in as much detail as you can remember. If
necessary, attach
a
dd
ition
a
l
sheets
to this
f
o
r
m
.
It’s
also important that you include
as
much
as y
ou
remember of any conversation you or others had with the fire/ems staff or any
actions taken by the staff. Describe in detail what you feel the staff or any fire/ems department
employee did that should be recognized.
Citizen commendations will be forwarded to the
Director of Public Safety
,
the
employee’s
supervisor,
the
co
mm
e
nd
e
d
employee and to their personnel file.
Thank you for taking the time to recognize the hard work and dedication of our employees
CottageGrove Fire/EMS Department
COMMENDATIONREPORT
Cottage Grove Public Safety collectively serves our community
compassionately providing protection of life and property.
We do this with honor, integrity, pride and professionalism.
We are Cottage Grove Public Safety.
Citizen Information (person reporting commendation)
CitizenName HomePhone OtherPhone
Address(IncludeStreetAddress,City,StateandZipcode)
Commendation Information
IncidentDateandTime IncidentLocation CaseNumber(IfKnown)
EmployeeName(Badgenumberifknown) AdditionalEmployeeName(IfApplicable) AdditionalEmployeeName(IfApplicable)
WitnessName WitnessAddress WitnessPhonenumber
WitnessName WitnessAddress WitnessPhonenumber
Describe Basis for Commendation (attach additional sheets if necessary)
(Continue on Page 3 if more room needed)
CitizenSignature Date
Receipt and Disposition Information (to be completed by Fire/EMS)
EmployeeReceivingReport Date/TimeReceived Referredto
Commendation
Officer File
DateCommendationForwarded CaseNumber
CottageGrove Fire/EMS Department
COMMENDATIONREPORT
Commendation
Continuation
Describe Basis fo
r Commendation (Continuation)