COMPLAINT RECORD FORM Details of person making the complaint Note: This form can be completed electronically or by hand. Date complaint received: Does the person making the complaint wish to remain anonymous? YesNo Category of person making complaint: Select An OptionParticipantFamily memberFriendAdvocateGuardianManagerOther providerStaff memberOther Preferred method of contact: Select An OptionPhoneEmailLetter (if participant is not the person making the complaint) Participant details Is the participant an existing client? YesNo (if complainant is not the participant) Complaint details Current status of complaint: Select An OptionInvestigatingAction proposedResolved SUBMIT
