STATEMENT OF RIGHTS
I wish to advise you that you are being questioned as part of an official investigation of the ______ Department. You will be asked questions specifically, directly, and narrowly related to the performance of your official duties as a _____ or concerning your fitness for service as a ____. You have the constitutional right not to incriminate yourself.
Under no circumstances will your statement be used in any subsequent criminal court action against you. However, factual information contained in the internal affairs file on this investigation, including your statement, is generally discoverable in civil rights litigation filed in federal or state court and may be used to impeach your testimony. In addition, this factual information may be used in any criminal proceeding in which you are a witness.
I further wish to advise you that if you refuse to give a statement or answer questions relating to the performance of your official duties or fitness for duty, you will be subjected to departmental charges that could result in your dismissal from the ____ Department.
Signed _______ (Interviewer).
I have read the above and understand it fully. I sign this statement having been advised of the above rights before any questions have been asked of me.
Signed _______ (Police officer or Firefighter).
Date and time _________.
IC 36-8-2.1-5