Client Complaint Form

This form is to assist you in making a complaint to our organisation. All persons wishing to make a complaint can speak with the Manager or staff member of choice or choose to complete this form. All information is strictly confidential. If you feel unsure about anything or would like help to complete this form, please speak to the Administration Officer. We encourage you to make your complaint in writing. Please allow a maximum of ten (10) days for a response.

Have you lodged a complaint with our organisation before? (required)

Yes, the matter was resolvedYes, the matter was not resolvedNo

Is there someone else (legal representative or support person) that you would like involved in making this complaint? (required)

Yes No

What is the complaint related to? Please select one or more boxes (required)

Employee of the organisationVolunteer of the organisationService deliveryFacilitiesSpecific incident

Did someone witness the incident? Would they be willing to be contacted regarding your complaint? If so, please provide the name and contact details. (Inform the witness that they may be contacted by the organisation to discuss the matter)

If yes, what was the outcome, if any? You will be asked to provide a copy of your complaint to the respondent and any letter of reply you may have received

If no, is there any reason/s that you cannot do so? Do you need help to do this, e.g. for safety reasons, cultural reasons?

How would you like to see your complaint resolved? What action would you like the organisation to take to resolve your complaint?

Please provide any copies of documents that may help us to handle the complaint, e.g. if you have letters, emails or faxes or records of conversations you have had with the person/s associated with the complaint.

To help us resolve this matter as fast as we can, please ensure your contact details are kept up to date. If details change, let the organisation know as soon as you can.

Client Complaint Form

Personal details

Details of the complaint