United Supports complaint form

United Supports Complaint/Feedback Form

Please complete the form below for complaints and feedback
Date of filling the form:*

MonthDayYear
Date
You may choose to be anonymous while filling out this form. Please understand that by choosing to be anonymous your complaint will not be treated with any less urgency or attention, but there will be no way of notifying you about how the complaint is handled.
Complainant's Name:
Phone Number
Please enter a valid phone number.
Who is this complaint about?*

Staff member(s)Coworker(s)Participant(s)Other
Name of the person or service against which/whom the complaint is filed (include contact details if known):*
Nature of the complaint:*

Diversity and Inclusion relatedHostile/uncomfortable work environmentPolicy issuesOther
The specific details of the complaint, please include what happened, where it happened and who is involved:*
What outcomes are you seeking as a result of this complaint or feedback?*
Please attach any copies of documentation that may help us to investigate your complain/feedback e.g letters, references, emails etc.

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United Supports Complaint/Feedback Form