Complaint form | No Limits Community Services

Part A – About me

Full Name:

Part B- About the complainant (if different to above).

Fill in this box if you are complaining on behalf of someone else

First

Last

What is your relationship to that person?

Does the person know you are making this complaint?

Does the person consent to the complaint being made?

Fill in this box if someone is assisting you with the complaint – for example a family member, your nominee or representative.

Name of representative

First

Last

Organisation

Postal Address

Contact Numbers

Business:

Mobile:

Fax

TTY

Email *

Please enter your email, so we can follow up with you.

My preferred contact is: *

This document is uncontrolled when printed, please refer to the Policies and Procedures Portal for the current controlled version Accountable: Leadership Effective Date: 18 Aug 2020 Review Date: 18 Aug 2023 Responsible: Board Revision Number: 1 Page 1 of 4

Part C – Your complaint

What is your complaint about? Provide some details to help us understand your concerns. You can include what happened, where it happened and who was involved or the decision made that you are unhappy about. *

This document is uncontrolled when printed, please refer to the Policies and Procedures Portal for the current controlled version Accountable: Leadership Effective Date: 18 Aug 2020 Review Date: 18 Aug 2023 Responsible: Board Revision Number: 1 Page 2 of 4

Part D – Who is your complaint about?

Name/organisation *

Address

Post Code

Contact Numbers

Home

Business

Fax

Mobile

TTY

Email *

What is this person’s/organisation’s relationship to you? *

What outcomes are you seeking? *

This document is uncontrolled when printed, please refer to the Policies and Procedures Portal for the current controlled version Accountable: Leadership Effective Date: 18 Aug 2020 Review Date: 18 Aug 2023 Responsible: Board Revision Number: 1 Page 3 of 4

Part E – Further information

NOTE: If you want to complain about more than one person, please provide this additional information on an extra page.

Supporting information Please attach copies of any documents that may help us investigate your complaint (for example letters, references, emails).

File Upload

Click or drag a file to this area to upload.

Please check this box to consent No Limits Community Services to work with the necessary parties involved in this complaint in order to resolve this issue.

No Limits, its employees and agents do not accept any liability for action arising from any error, omission or incomplete information provided. ABN 96 169 745 000 © No Limits Community Services.

This document is uncontrolled when printed, please refer to the Policies and Procedures Portal for the current controlled version Accountable: Leadership Effective Date: 18 Aug 2020 Review Date: 18 Aug 2023 Responsible: Board Revision Number: 1 Page 4 of 4