Free Government Complaint Form Template
Government Complaint Form
Please complete all sections to ensure your complaint is reviewed and addressed appropriately.
Personal Information
Name
Address
Phone Number
Identification Number (if required)
Complaint Details
Date of Incident
Government Department/Agency Involved
Location
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Office
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Facility
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Service Location
Staff Member(s) Involved (if applicable)
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Name(s) |
Contact Number |
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Nature of Complaint
Check all that apply:
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Service Delay
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Unprofessional Staff Behavior
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Incorrect Information or Assistance
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Facility Condition or Accessibility
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Policy or Regulation Concern
Description of Incident
Provide a detailed account of the issue, including dates, times, and relevant interactions. Attach additional pages if necessary.
Action Taken
Have you reported this issue to anyone else?
If yes, please specify:
Desired Resolution
Describe how you would like this to be resolved.
Supporting Document
Upload a file to support the complaint.
By signing below, I affirm that the information provided is accurate to the best of my knowledge.
Name:
Signed:
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