Making a Complaint to The Perpetual People Co.

Details of person making the complaint

Date complaint received:

Name of person receiving complaint:

Position:

Does the person making the complaint wish to remain anonymous?

Yes

No

If no, name of the person making the complaint:

Category of person making the complaint:

(Participant/Family member/Friend/Advocate/Guardian/Manager/Other provider/Staff member/Other)

Preferred method of contact:

Phone

Email

Letter

Phone:

Email:

Postal Address:

Participant details

Name of participant the complaint is regarding:

(If participant is not the one making the complaint)

Is the participant an existing client?

Yes

No

Can we speak to the participant about this complaint?

(If complaint is not the participant)

Yes

No

Complaint details

Description of complaint

What is considered appropriate resolution by the person making the complaint?