Complaint Lodgement Form

Complainant
Name of person making the complaint
First Last
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
Please specify organisation
Details of Complaint
Date complaint is being lodged:
Date Format: MM slash DD slash YYYY
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
Untitled

Complainant