Los Santos Emergency Services

Submitter Details:

Full Name *
First and Last Name: "John Doe"

Place of Residence *
Street Number and Name, City/County, State OR N/A if None

Phone Number *
Your Current Telephone Number

Current Occupation *
Your current workplace, or N/A if none.

Employee Details:

Full Name *
LSES Employee's First and Last Name: "John Doe"

Badge Number
LSES Employee's 4-digit badge number, if known

Employee Description (If Full Name Unknown)
Clothing, hair, tattoos, facial features, uniform, vehicles, etc.

Occurrence Details:

Date and Time of Reported Occurrence *

Give a detailed explanation of what happened during the occurrence from your perspective *

Additional Information

What does LSES stand for?:
This question is a means of preventing automated form submissions by spambots.