Complaint Form

GCRS Complaint Form

Do you wish to remain anonymous? *

YesNo

If you remain anonymous, we may not be able to contact you to discuss your complaint or update you on the outcome of your complaint.

First Name *

Last Name

Preferred method of contact *

PhoneEmailFace-to-face

Best contact number *

Email Address *

Does this complaint specifically involve a GCRS participant? *

YesNo

This will assist us in making sure that the participant is safe and supported during the complaint process.

Participant full name (if known) *

Does the complaint involve alleged assault, abuse or neglect of a participant? *

YesNoUnsure

Does the complaint involve alleged criminal action? *

YesNoUnsure

Are you wishing to make a Formal Complaint or Concern for Follow Up? *

Formal ComplaintConcern for Follow Up

Description of Complaint *

Do you have any documents or photos that you would like to attach? *

YesNo

Please upload your files / photos

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Please outline any attempts you have made to resolve the matter (if applicable)

What do you feel is required to resolve the matter? *

Date *

Investigating Officer's Report

Name *

Position *

Investigation / Outcomes / Actions *

Learned Outcomes / Prevention Strategies *

Evidence

Is the complaint open or closed? *

OpenClosed

Signature *

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Date *

CEO's Sign-Off

Further details (if required

Signature *

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Date *

Administration

All details have been entered into Complaints Register and file has been saved to the appropriate location *

Signature *

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Date *