Complaint Record Form

    Date complaint received*
    Name of the person receiving complaint*
    Position*
    Does the person making the complaint wish to remain anonymous?

    Name of the person making complaint*
    Category of person making complaint*

    Preferred method of contact*

    Name of the person making complaint*
    Phone *
    Email *
    Residential Address*

    (if participant is not the person making the complaint)

    Participant Details

    Name of the participant complaint is regarding*
    Is the participant an existing client?

    (if participant is not the person making the complaint)

    Complaint Details

    What is considered appropriate resolution by the person making the complaint?*
    Unresolved What actions have been proposed? Or if resolved, how was it resolved?*
    Current status of complaint*

    Description of complaint*
    Drag & Drop Files Here*

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