Complaint Record Form

Complaint Record Form
Please complete this form to lodge a formal complaint, please ensure you have discussed the matter with the applicable Team Leader prior to submitting a formal complaint. This form must be done solely by the person filing the complaint, with no input from external sources. Please note this can be used as evidence and provided to the person the complaint is regarding during the investigation.
Please note staff are required to attempt to resolve issues with their co-workers prior to submitting a complaint form, this form is to be used as a last resort. Have you discussed your concern with the person it involves as well as your team leader?

No, discontinue this form and discuss with applicable person/sYes, issue continues to occurOther
Part A: About You

Formally known as the "Complainant"
Name*
Date*

DayMonthYear
Date
Address*

Street Address

CityState

Postal / Zip Code
Phone Number*
Email*
If you require assistance to participate in the complaint process, please outline the assistance you require:
Acting on behalf of another person:
If you are complaining on behalf of someone else, please provide the Name and Address of the person making the complaint.
Part B: Who is the Complaint about?

Formally known as the "complaintee"
Name of person or organisation*
Person or organisations address (If known, for GOCare staff please list GOCare's address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your relationship to this person?*
Note: If your complaint is about more than one person or organisation, please provide information about each additional person or organisation.
Part C: What is your Complaint about?

For information about the different types of complaints visit the Australian Human Rights Commission website: https://humanrights.gov.au/our-work/complaint-information-service/information-people-making-complaints
When did the alleged event/s happen:*
What happened? Describe the events that you want to complain about. *
We need to know what you say happened, where it happened and who was involved. Please give us all the details you can remember.
Further notes:
If required
Were there any witnesses?*
What is considered an appropriate resolution by the person making the complaint?*
Part D: Lodging the Complaint

Please sign below and then click submit. Your complaint will be sent to the People & Culture department, you will receive an acknowledgement via text or email within 2 business days of lodging your complaint.
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Complaint Record Form

Part A: About You

Part B: Who is the Complaint about?

Part C: What is your Complaint about?

Part D: Lodging the Complaint