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Every Human Complaints Form

We take all complaints seriously, the information that you provide will help us to improve the quality of our services. Complaints can be made by participants, staff, family and other providers.

If you feel that your complaint has not been resolved or needs more time and attention, please contact us and we can give you an update 1800 705 930

Person Making the Complaint

Name of person making this complaint

Date complaint is being made

Is this a first notification of this complaint?

YesNo

If this complaint has been made previously, please select

Complaint was not resolved I am not happy with the resolution It has occurred againComplaint was made verbally

Participant Name (if this complaint is on behalf of a participant)

Is the participant aware that you are making this complaint

YesNo

Details of People involved or Complaint is about

Name of person involved or complaint is about

Details complaint

Where did this occur?

When did this occur?

Were any third parties notified of this Complaint?

NDIS / NDIASupport Coordinator Family / Nominated Support Emergency Services (Police, Ambulance, Fire) Other

Is this complaint a result of an Incident?

YesNo

Outcome

What is the desired outcome of this complaint?

Do you wish to be contacted throughout the investigation?

YesNo

Is there anyone else that would like to be contacted during the investigation?

YesNo

Was Management informed

YesNo

Please list anyone who would like to receive contact and updates

Acknowledgements

We appreciate the time you have taken to provide us with this information. We will investage any concerns and if you have provided your contact information, we will be in touch soon to advise on what we have done, what we intend to do and how we will resolve your complaint.

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