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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*

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Address*

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Email*

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Phone*

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Date and time of incident*

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Where did the incident take place?*

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Description of Issue*

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Was there a witness to the incident?

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Name of witness*

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Address of witness*

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Phone number of witness*

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

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Please provide details*

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Please sign here*

Sign Above

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Today's date*

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CAPTCHA*

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Central Desert Regional Council