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    {
        "page": 1,
        "items": [
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 192.48,
                    "t": 719.28,
                    "r": 418.8,
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                },
                "text": "Incident / Complaint Report Form",
                "reading_order": 0,
                "level": 1
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 441.36,
                    "t": 761.76,
                    "r": 544.08,
                    "b": 749.76
                },
                "text": "Date Received on:_____",
                "reading_order": 1
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 441.6,
                    "t": 741.6,
                    "r": 582.24,
                    "b": 729.12
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                "text": "BY:_____",
                "reading_order": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 441.12,
                    "t": 726,
                    "r": 586.32,
                    "b": 714.72
                },
                "text": "<div style=\"text-align: center;\"><img src=\"imgs/img_in_image_box_0_0_636_78.jpg\" alt=\"Image\" width=\"99%\" /></div>\n",
                "reading_order": 3
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.84,
                    "t": 676.8,
                    "r": 513.36,
                    "b": 660.72
                },
                "text": "Complainant's Name: ___",
                "reading_order": 4
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.36,
                    "t": 654.96,
                    "r": 510.72,
                    "b": 638.64
                },
                "text": "Mailing Address: ___",
                "reading_order": 5
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.84,
                    "t": 632.64,
                    "r": 258.24,
                    "b": 617.04
                },
                "text": "Phone: ___",
                "reading_order": 6
            },
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 69.84,
                    "t": 591.12,
                    "r": 221.52,
                    "b": 576.24
                },
                "text": "Complainant's Status:",
                "reading_order": 7,
                "level": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 70.56,
                    "t": 570.72,
                    "r": 274.56,
                    "b": 554.64
                },
                "text": "□ Employee □ Job Applicant",
                "reading_order": 8
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 73.68,
                    "t": 570.48,
                    "r": 421.44,
                    "b": 554.64
                },
                "text": "Department Customer",
                "reading_order": 9
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 70.08,
                    "t": 529.68,
                    "r": 536.88,
                    "b": 496.08
                },
                "text": "Date, time, and place of the incident(s): ___",
                "reading_order": 10
            },
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 69.84,
                    "t": 473.28,
                    "r": 180.24,
                    "b": 458.4
                },
                "text": "Documentation:",
                "reading_order": 11,
                "level": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 70.08,
                    "t": 452.16,
                    "r": 504.96,
                    "b": 437.04
                },
                "text": "Please attach copies of any documents or material you believe are relevant.",
                "reading_order": 12
            },
            {
                "page": 1,
                "type": "TITLE",
                "location": {
                    "l": 68.88,
                    "t": 409.68,
                    "r": 147.12,
                    "b": 394.56
                },
                "text": "Witnesses:",
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                "level": 2
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 68.88,
                    "t": 388.08,
                    "r": 534.96,
                    "b": 359.04
                },
                "text": "Did anyone witness the incident(s)? If so, please list names and phone numbers of any witnesses to the incident(s). Use additional pages, if necessary.",
                "reading_order": 14
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 69.84,
                    "t": 334.08,
                    "r": 404.64,
                    "b": 320.64
                },
                "text": "Name: ___",
                "reading_order": 15
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 368.88,
                    "t": 334.32,
                    "r": 520.32,
                    "b": 320.16
                },
                "text": "_Phone: _____",
                "reading_order": 16
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 67.92,
                    "t": 295.2,
                    "r": 398.4,
                    "b": 281.04
                },
                "text": "Name: ___",
                "reading_order": 17
            },
            {
                "page": 1,
                "type": "TEXT",
                "location": {
                    "l": 369.12,
                    "t": 294.96,
                    "r": 520.32,
                    "b": 280.56
                },
                "text": "_Phone: _____",
                "reading_order": 18
            }
        ]
    },
    {
        "page": 2,
        "items": [
            {
                "page": 2,
                "type": "TITLE",
                "location": {
                    "l": 69.36,
                    "t": 719.28,
                    "r": 146.64,
                    "b": 703.2
                },
                "text": "Statement:",
                "reading_order": 0,
                "level": 2
            },
            {
                "page": 2,
                "type": "TEXT",
                "location": {
                    "l": 68.16,
                    "t": 698.16,
                    "r": 531.36,
                    "b": 640.32
                },
                "text": "Please describe the incident(s) as clearly and concisely as possible. Provide as much detail as you can recall, including when and where the events occurred and who said what to whom. Explain why you believe the conduct or treatment was discriminatory. Use additional pages, if necessary.",
                "reading_order": 1
            },
            {
                "page": 2,
                "type": "TITLE",
                "location": {
                    "l": 69.36,
                    "t": 418.32,
                    "r": 174.48,
                    "b": 401.76
                },
                "text": "Action Sought:",
                "reading_order": 2,
                "level": 2
            },
            {
                "page": 2,
                "type": "TEXT",
                "location": {
                    "l": 68.4,
                    "t": 396.72,
                    "r": 456.96,
                    "b": 381.12
                },
                "text": "Please describe what you would like to see done to correct the situation.",
                "reading_order": 3
            }
        ]
    },
    {
        "page": 3,
        "items": [
            {
                "page": 3,
                "type": "TITLE",
                "location": {
                    "l": 69.36,
                    "t": 719.28,
                    "r": 237.12,
                    "b": 703.2
                },
                "text": "Complaint Authorization",
                "reading_order": 0,
                "level": 2
            },
            {
                "page": 3,
                "type": "TEXT",
                "location": {
                    "l": 68.88,
                    "t": 697.92,
                    "r": 535.2,
                    "b": 654.24
                },
                "text": "I understand that complete confidentiality cannot be maintained in the process of handling informal and formal complaints. I agree that this statement of allegations may be used during the investigation of the incident.",
                "reading_order": 1
            },
            {
                "page": 3,
                "type": "TEXT",
                "location": {
                    "l": 68.4,
                    "t": 610.8,
                    "r": 526.08,
                    "b": 581.76
                },
                "text": "I affirm that this complaint statement is true, accurate, and complete to the best of my knowledge.",
                "reading_order": 2
            }
        ]
    }
]