Complaints – Questionnaire

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Complaints – Questionnaire

We would appreciate your help completing this short questionnaire to help us improve our Complaint Procedures.

Name:________________________________________________________________________________

Signature:__________________________________________                           Date:____/____/_____

 

Overall how satisfied are you with the results from the Complaint Procedure?  (Please circle one)

Very Satisfied         Satisfied         Neither satisfied or dissatisfied         Dissatisfied         Very Dissatisfied

  1. Did you receive a letter of receipt if you made your complaint in         Yes         No          N/A

writing?       

 

  1. Was your complaint investigated fairly, impartially, promptly and         Yes         No          N/A

 thoroughly? If no, please provide comments.

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

  1. Were the results of the investigation communicated to you in writing?         Yes         No          N/A

 

  1. If you weren’t happy with the outcome of the investigation, were you         Yes         No          N/A

offered an external review of your complaint?

Please provide any suggestions about how we may improve our Complaint Procedure below.
 

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________
 

 

 

Thank you for your time. Please use the addressed and stamped envelope to return this form or hand directly to the Nominated Supervisor.

 

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