Complaint and Feedback Form
Our service is committed to providing high quality care and supports that meet our clients needs. We value your feedback – including complaints, and take all forms seriously and respectfully. Please complete the form below to make a complaint or express your feedback.
Section 1: Your details
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 compliant is handled.
Do you want to remain anonymous?
*
Yes, I want to remain anonymous.
No, I will provide my name and contact details below.
Personal Details
(of the person filling out this form)
Full Name
Address
Street Address
Street Address Line 2
Suburb
State
Post Code
Phone Number
-
Area Code
Phone Number
Email
Are you providing feedback on another person’s behalf?
Yes (go to Section 2).
No (go to Section 3).
Section 2: Feedback made on another person’s behalf
Please provide the following details about the person on whose behalf you are acting.
Full Name
Address
Street Address
Street Address Line 2
Suburb
State
Post Code
Phone Number
-
Area Code
Phone Number
Email
Are you a legal representative for the person who is, or was, receiving the service? (e.g. parent of a child under 18 years or guardian appointed by court order)
Yes
No
If yes, please provide details
Does the person know you are making a complaint on their behalf?
Yes
No
If no, please provide the reason why
Section 3: Provide details of your complaint or feedback
Please provide as much detail as possible, so we can investigate your complaint and implement quality improvements.
Complaint or feedback category
NDIS Accommodation Services
NDIS Community Services
NDIS Employment Support Services
Finance and Accounts
Work Health and Safety
Abuse or Neglect of a Person Receiving Services
Other
Please provide details of your main concerns, including what events led to making the complaint or feedback, location, approximate dates/times and who was involved.
Please attach copies of any documentation that may help us to investigate your complaint/feedback (e.g. photos, emails, letters).
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What outcomes would you like as a result of providing your feedback?
Section 8: Privacy
Safe Living Australia is committed to protecting your privacy. We collect and handle personal information that you provide on this form for the purpose of investigating and responding to your concern. Safe Living Australia will only use your information in accordance with relevant privacy and other laws. If you choose to remain anonymous, please remember that we are unable to respond to your complaint or feedback.
Thank you for taking the time to provide feedback about our service.
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