Butter Fish Services – Complaint Form

This form will be used to express concerns and record suspicion, allegation or a complaint of unsatisfactory and inappropriate behaviour about the organisation or a representative of the organisation.

Please complete all sections and contact your direct supervisor if you need assistance.

If you have difficulty filling out the online form below you can download a PDF version of the BFS Complaint Form and scan + email to admin@butterfish.com.au

For more information about NDIS Quality and Safe Guards Commission complaints please visit the NDIS Quality and Safeguards Commission Website.

Complaint Handling Form

Complaints Handling Form

Name

Email Address

Phone Number

Name of person/s involved

Name of person making the complaint

Name of person whom the complaint is made against.

Nature of Complaint - include the time, date, location and what happened.

Details of what happened:

Details of any injuries sustained and if the person received medical attention.

Accurately as possible record what the complainant said when describing what happened.

Provide details of anyone who witnessed what happened.

Does this complaint indicate the possibility of abuse? Does this complaint indicate the possibility of abuse? Yes No

If yes, please provide details of your report. (Include; Person you reported to, date and additional Comments).

If the complaint relates to inappropriate behavior, provide details of internal processes followed.

Has the incident been resolved? Has the incident been resolved? Yes No

Further steps to be taken by Butter Fish Services Pty Ltd to resolve the matter?

Is any follow up required? Is any follow up required? Yes No

If yes, please provide details.

Number

13 + 2 =