Complaint Lodgement Form

Conflict Resolution Service welcomes feedback, both positive and negative, as a guide for continuous improvement. We support the right of stakeholders to make a complaint and for that complaint to be addressed in a timely and sensitive manner without bias or discrimination against anyone involved.

By submitting this form to Conflict Resolution Service, you are confirming that you would like this information treated as a complaint, and as such understand that Conflict Resolution Service will follow its Complaints Policy. Please contact admin@crs.org.au if you would like further information about this policy.

CRS Complaint Form

1. Your Information
Providing your information will help CRS to investigate your complaint. You can choose to remain anonymous, but this may impact our ability to investigate the matter. Should you choose to provide your information, please be assured that it will be managed confidentially. If you are writing on someone else’s behalf, please also include their details.
Name*
Phone*
Email*
Address*
On behalf of: (If applicable)
Name
Phone
Email
Address
2. Your Concerns
Service Accessed
Service Accessed
Date of Service
MM slash DD slash YYYY
Location of Service
Location of Service
CRS staff members involved (if known)
CRS staff members involved (if known)
Your Concerns*
To the best of your ability, please give an overview of the concerns you have with the service/s provided by Conflict Resolution Service. Where possible, please give specific examples and information.
Please attach any documents which may help us to investigate your complaint (Optional)
Please attach any documents which may help us to investigate your complaint (Optional)
Max. file size: 50 MB.
3. Your Desired Outcome [Please provide information on what you would like to happen as a result of your complaint]
Please provide information on what you would like to happen as a result of your complaint.*
In raising your concerns with the Conflict Resolution Service, what outcome are you expecting? Please be advised the Conflict Resolution Service reserves the right to determine a suitable outcome based on its review and investigations.
Have you previously contacted CRS about this issue?
Have you previously contacted CRS about this issue?
- Yes
- No
4. Do you require the following supports in making your complaint?
Telephone Typewriter
Telephone Typewriter
- Yes
- No
Interpreter Service
Interpreter Service
- Yes
- No
Advocacy Service
Advocacy Service
- Yes
- No
5. Permission to Contact Others
Permission to Contact Others
It may be necessary for Conflict Resolution Service to speak with individuals (including staff of other services) outside of Conflict Resolution Service, in order to gain additional information about your complaint. Are there any other individuals who Conflict Resolution Service may contact to assist with additional information about your complaint? (Please add specific comments on any information you would like Conflict Resolution Service to keep confidential from the individual, otherwise Conflict Resolution Service will assume any aspect of your complaint can be discussed with the person/s you have nominated below).
6. Declaration
I declare the information I have provided is true and correct.
Signature
Date
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Thank you for taking the time to provide us with your feedback.

Who else can you contact?

For	Who	Link
Discrimination and breaches of human rights: Complaints about services for children and young people and their carers, and people with disability and their carers	ACT Human Rights Commission	ACT Human Rights Commission Complaints
Conduct as a registered charity	Australian Charities and Not-for-profits Commission	How to raise concerns about charities
Criminal offence	ACT Policing	ACT Policing: Contact with us

Privacy

CRS is committed to protecting your privacy. We collect and handle personal information that you provide on this form for investigating and responding to your complaint, compliment or feedback.

We will only use your information in accordance with relevant privacy and other laws. For us to provide the best possible service, we may need to share your personal information with others, such as advocacy or health-related organisations or businesses, to assist with any concerns identified.

Please be advised that CRS may use and publish positive feedback to promote our services. No personal or identifying information will be used. If you do not want your feedback to be published, please let us know.

If you choose to remain anonymous, CRS may be unable to respond to your complaint or feedback.

If you wish to contact CRS about the information that you provide on this form, please call 6189 0590 or email admin@crs.org.au.

Complaint Lodgement Form

CRS Complaint Form

1. Your Information

On behalf of: (If applicable)

2. Your Concerns

3. Your Desired Outcome [Please provide information on what you would like to happen as a result of your complaint]

4. Do you require the following supports in making your complaint?

5. Permission to Contact Others

6. Declaration

Who else can you contact?

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