Complaints and Feedback

Anonymous Complaint and/Or Feedback

DETAILS OF THE COMPLAINT or FEEDBACK – Please complete details for each item where applicable

Name of Service

Name of Person you are complaining about or wish to give feedback about

Does the person know you are making this complaint/providing feedback?

Yes
No

Please provide details of your preferred contact to provide outcome and feedback to you?

Name

Phone number

email address

What is your Complaint/Feedback about?
Provide details to help us understand your concerns.
You should include what happened, where it happened, time it happened and who was involved

Date

Time

AM
PM

What Happened?

Where did it happen

Who was involved

Add any other detials that would assist with this.

Supporting Information
Please attach copies of any documentation that may help us to investigate your complaint/feedback (for example letters, references, emails).

Supporting Information

What outcomes are you seeking as a result of the complaint/feedback?

PPDS Office Use Only

Date Received

Action taken or required

Date Action completed

Signature

Check word: