Customer Complaint Form

Before filling out this form you should read the External Complaints Policy and the Customer Service Charter, in particular Attachment B, Customer Complaint Handling Procedure.

Attachment A has a version of this form that you can print and fill in if you wish.

Personal Details

Name*

Invalid Input

Address*

Invalid Input

Email*

Invalid Input

Phone*

Invalid Input

Date and time of incident*

Invalid Input

Where did the incident take place?*

Invalid Input

Description of Issue*

Invalid Input

Was there a witness to the incident?

Invalid Input

Name of witness*

Invalid Input

Address of witness*

Invalid Input

Phone number of witness*

Invalid Input

As a result of this complaint, is there any outcome you would like?

Invalid Input

Please provide details*

Invalid Input

Please sign here*

Sign Above

Invalid Input

Today's date*

Invalid Input

CAPTCHA*

Invalid Input

Central Desert Regional Council