Complaint Lodge Form

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B6.12 COMPLAINT LODGEMENT FORM

"*" indicates required fields

Complainant

Name of person making the complaint

File as Anonymous

Anonymous

Address

Phone

Home

Work

Mobile

Email

Person on whose behalf complaint is being made

(leave blank if same as Complainant)

Name of Person

First Last

Address

Phone

Home

Work

Mobile

Email

The complainant is a*

Client

Organisation

Advocate/Friend

Family Member

Staff Member

Neighbour

Other

Please specify organisation

Details of Complaint

Date complaint is being lodged:

If complaint is about a person or a group of people, what are their names?

BYS service or program area that is the subject of the complaint (if known):

Location of service / program (if known):

Location of the property if complaint is about a tenant or housing property:

Provide a summary of the issues of the complaint

Please provide additional pages or documentation if necessary

Max. file size: 2 MB.

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