Complaint Report Form

Report Information

Date Received*

Received by*

Person Investigating*

Nature of the Complaint*

E.g. Poor handling of accident/injury, Poor Customer Service, Poor Quality of service, Misleading Marketing.

Service Type*

Complainant Details

Name*

Contact Phone Number

Contact Email Address

Relationship

Incident Details

Date of Incident*

Approximate Time of Incident

Location of Incident

Was the Complaint through email or social media platforms?*

Yes

Description of Incident

Describe the incident in detail, including exactly what happened, where it occurred, if there were any witnesses and contributing factors why it may have occurred, where possible.

Screenshot of Complaint

If the complaint was via email or social media platforms, please screenshot the conversation and upload here.

Drop files here or

Max. file size: 18 MB, Max. files: 5.

Immediate Actions after the Incident*

Describe any immediate actions taken to address the incident.