COMPLIMENT AND COMPLAINT FORM 24-25

COMPLIMENT AND COMPLAINT FORM
Thank you for taking the time to complete this feedback sheet. We will use your comments to improve our business. This is a confidential document, and names are not required. An effective feedback, compliment and complaint handling system addresses the principles of visibility and accessibility, responsiveness, assessment and investigation, feedback, improvement focussed and service excellence. Our service is committed to providing high quality care and services and meeting your needs. We value your feedback - including complaints. Please let us know what we do well and where we can improve our services.
This is a:

ComplimentComplaintFeedback
These are things that you think we're doing well or may be recognition of a person who provides a service to you. By telling us what you like, we can aim to continue to do these things and provide feedback to staff.

Your ideas on how we can improve things or do things better can help us to improve our services.

We want to know when you're not happy about an experience you've had with Permalink. A complaint can be about a person, a service or something you have experienced. If we need to contact you, it'll be from a private number. For privacy reasons, we can't leave a message. Unless your voicemail clearly identifies who you are.

Please be clear, factual, and tell us the outcome you would like. Providing your name and contact details will also help us to get in touch and help resolve the issue. If you provide feedback anonymously, we won't be able to respond to you personally. How we'll respond We aim to resolve complaints within 10 working days. If we can't resolve your complaint, we will explain why and let you know what other options you have. If the matter is urgent, please email support@permalink.com.au or contact us on 1300 737 625, option 2 to speak to management.
Section 1:

Your Details
Do you want to remain anonymous?

YesNo
Name

First NameLast Name
Postal address
Telephone number
Mobile number
Email address
example@example.com
Do you require an interpreter? (We will arrange Translating and Interpreting Service (TIS) on 1314 50)

YesNo
Type a question
What is your relationship to Permalink? Please select statements that apply

I am a person with a disability, and I receive services from PermalinkI am a person with a disability, but I do not receive services from PermalinkI am Care team member of a person with a disability who receives services from PermalinkI am a family member of a person with a disability who receives services from PermalinkI am a friend of a person with a disability who receives services from PermalinkI work for a government body, am an advocate or work for an advocacy organisationI am a Permalink staff memberOther
Section 2:

Please state your feedback/concern.
Please provide details of your feedback/concerns, including what events led to making the complaint, compliment or feedback, approximate dates and who was involved.
Section 3:

What action have you already taken in relation.
Have you discussed with Permalink Support Services' Client Service Manager, your support coordinator, NDIS or any other agency or person for assistance with these concerns?

YesNo
If yes with whom and what was the outcome
Section 4:

What outcomes would you like as a result of providing your feedback
Type a question
Section 5:

What other improvement do you suggest for our organisation
Section 6:

Privacy
Permalink Support Services is committed to protecting your privacy. We collect and handle personal information that you provide on this feedback form for the purpose of investigating and responding. Permalink Support Services will only use your information in accordance with relevant privacy and other laws. For us to provide services to you effectively and efficiently, we may need to share your personal information with others, such as NDIA that deals with the matters identified in your feedback. If you choose to remain anonymous, Permalink Support Services may be unable to deliver the full range of services you require. If you wish to contact Permalink Support Services who are responsible for managing the personal information that you provide on this form, please get in touch with us: Visit Us: 164 Rosebank Avenue, Clayton South VIC 3169 Call Us: 1300 737 625, option 2 Email Us: support@permalink.com.au I You can also submit this feedback visit www.permalink.com.au/feedback
Section 7:

Declaration
Signature

Clear
Date

MonthDayYear
Date
Thank you for taking the time to provide feedback about our service.

Other agencies that can help with a complaint: National Disability Insurance AgencyTelephone: 1800 800 110 Email: enquiries@ndis.gov.au Telephone: 1800 677 342 (free call) Disability Services Commissioner

Department of Education and Training Department of Families, Fairness and Housing

TTY service for people with hearing or speech difficulties: Telephone: 1300 726 563 Email: complaints@odsc.vic.gov.au Telephone: 03 9637 2000 Email: complaints@education.gov.au Telephone: 1300 475 170

Compliment and complaint form - V1.1
Office of the Public Advocate (OPA)

Email: feedback@dffh.vic.gov.au Telephone: 1300 309 337

VACCHO (Victorian Aboriginal Community Controlled Health Organisation Inc

Website: www.publicadvocate.vic.gov.ar Telephone: 03 9411 9411 Email: enquiries@vaccho.org.au

Compliment and complaint form - V1.1
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