Feedback  

      

The form below should be used for any other feedback. Our Complaints Policy provides specific information on how feedback will be managed.

Your Details:
Title:   
Given Names:   
Last Name:   
Organisation:   
Prison:   
Address:   
Suburb: 
    State:      Postcode:   
Country:   
Email:   
Phone No:   
Fax No:   
Mob/Work No:   
Preferred Method of Contact:   
Gender:   
Ethnicity:   
Do you have a disability or other special need?   Yes  No
If yes, please specify: 
Do you require an interpreter?   Yes  No
Language/Dialect:   
Are you the person affected by the issue?   Yes  No
Relationship to person affected:   

Other Details:
(If you are representing someone we may need to confirm your authority to act for that person)
Title:   
Given Names:   
Last Name:   
Prison:   
Address:   
Suburb: 
    State:      Postcode:   
Country:   
Email:   
Phone No:   
Mob/Work No:   
Preferred Method of Contact:   
Gender:   
Ethnicity:   
Does the person affected have a disability or other special need?   Yes  No
If yes, please specify: 
Is an interpreter required?   Yes  No
Language/Dialect:   
Please indicate why you are representing this person: 

The Issue/Feedback:
Complaint Type:   
What part of the organisation does this relate to? 
Group:   
Division:   
Branch:   
Section:   
What happened and who was involved? (maximum 400 words) 
What would your preferred resolution be? 
Have you raised the issue before?   Yes  No
Are you prepared to be identified to the individuals involved?   Yes  No
Please provide details about the issue: 
When:   
Incident Location:   
If other, please specify:   
What happened and who was involved? (maximum 400 words) 
Have you raised the issue before?   Yes  No
If yes, what were you told and why are you still dissatisfied? 
Have you done anything about the issue already?   Yes  No
If yes, please specify: 
What would your preferred resolution be? 
Please provide details about the issue: 
When:   
Incident Location:   
If other, please specify:   
What happened and who was involved? (maximum 400 words) 
Have you raised the issue before?   Yes  No
Please provide details of your suggestion (maximum 400 words): 
Have you raised the issue before?   Yes  No
Are you prepared to be identified to the individuals involved?   Yes  No
Should you wish to change any information after it has been submitted you should contact the Complaint Coordinator on 1300 306 922 and quote the allocated reference number (this is provided after you have selected the "Submit" button).