Complaint form for formal Investigation

Complaint Form

Your Name (as complainant):
Date of Birth (as complainant):
Name of Women’s Aid staff member that the complaint concerns (if possible and relevant to enable us to identify records):
Please tick Women’s Aid Service that complaint refers to:

Please provide as much specific information as possible on dates, time and location:

Date
Time
:

Please tell us your contact details so that we can get back to you:

Please tick the box and sign here that you consent to and understand that in order to progress your complaint to the investigation stage of the Women’s Aid complaints policy; all your personal records stored by Women’s Aid and all your contact with Women’s Aid will need to be provided to the CEO and the employee appointed to investigate your complaint and any other WA employee on a need to know basis to progress the investigation.