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New South Wales
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Complaints
Complaint
Details of person making the complaint
Date complaint received
MM slash DD slash YYYY
Name of person receiving complaint
Position
Does the person making the complaint wish to remain anonymous?
Yes
No
Name of person making complaint
Category of person making complaint: (Participant/Family member/Friend/Advocate/Guardian/ Manager/Other provider/Staff member/Other)
Preferred method of contact
Phone
Email
Letter
Phone
Email
Address
Participant details
Name of participant
Complaint is regarding
Is the participant an existing client?
Yes
No
Can we speak to the participant about this complaint?
Yes
No
(if complainant is not the participant)
Complaint details
Description of complaint
What is considered appropriate resolution by the person making the complaint?
Current status of complaint
Investigating
Action proposed
Resolved Unresolved
What actions have been proposed? Or if resolved, how was it resolved?
Actioned and Entered in KPI Folder
Actioned by
Date
MM slash DD slash YYYY
