Complaint Form

The Community Place Complaint Form

This form is to assist you in amking a complaint to our organisation.

All persons wishing to make a complaint can speak with the Manager or staff member of their 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) business days for a response.

Personal Details

This information provided will be used to contact you. Only provide the contact details that you wish to be contacted on.

First Name

Last Name

Email Address

Postal Address

Street address

City

State

Postcode

Phone Number

Have you lodged a complaint with our organisation before? *

YesThe matter was resolvedThe matter was not resolvedNo

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

YesNo

Name

Phone

Email

Address

Street address

City

State

Postcode

What are the details of the incident?

Where it happened

When it happened (include date and time if possible)

Who was involved? (list all persons involved and witnesses)

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

Any other relevant details

Have you discussed the matter with the persons involved?

Yes No

If Yes, what was the outcome, if any? Please attach a copy (not the original) of your complaint to the respondent and any letter of reply you have received.

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

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

Additional Information/supporting documentation

Please attach copies of any documents that may help us to handle the complaint. EG if you have letters, emails 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.

Upload any relevant documents here

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