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This form can be submitted anonymously

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Doc No: Form02

Version No: 02

Version Date: 14/11/2022

Form02.

Complaint Report 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 Care Manager or one of the Leadership Team members.

  • All information is strictly confidential.

  • If you feel unsure about anything or would like help to complete this form, please speak to the admin person.

  • We encourage you to make your complaint in writing. Please allow a maximum of ten (10) days for a response.

  • Please upload any documents or images that may help us to handle the complaint.

  • If you still wish to raise this complaint about us to the NDIS commission, please contact 1800 035 544.

* required field

Source

Part A – About me

(If you want to raise this complaint anonymously, DO NOT complete this section)

Is there someone else (legal representative or support person) that you would like involved in making this complaint?
Are you making this complaint on behalf of someone else?
Does the person know you are making this complaint?
Does the person consent to the complaint being made?

Part B – Your complaint

* What is your complaint about?

(Provide some details to help us understand your concerns. You can include what happened, where it happened and who was involved)

Did someone witness the incident?
Would they be willing to be contacted regarding your complaint?

Please upload any documents or images that may help us to handle the complaint:

Upload Document
Upload Image
Upload Document
Upload Image

Thank you. Your form has been submitted.

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