Complaints

Details of person making the complaint

Date complaint received

Name of person receiving complaint

Position

Does the person making the complaint wish to remain anonymous?

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

Address

Name of participant

Complaint is regarding

Is the participant an existing client?

Can we speak to the participant about this complaint?

(if complainant is not the participant)

Description of complaint

What is considered appropriate resolution by the person making the complaint?

Current status of complaint

What actions have been proposed? Or if resolved, how was it resolved?

Actioned and Entered in KPI Folder

Actioned by

Date