Free Public Service Complaint Form Template
Public Service Complaint Form
Please complete all sections to ensure your complaint is reviewed and addressed promptly.
Personal Information
Name
Address
Phone Number
Complaint Details
Date of Incident
Public Service Involved
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Transportation
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Utilities
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Staff Member or Department Involved (if known)
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Name(s) |
Contact Number |
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Nature of Complaint
Check all that apply:
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Poor Service Delivery
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Delayed Response or Action
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Misconduct or Unprofessional Behavior
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Billing or Financial Issue
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Maintenance or Operational Issue
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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