EmailMeForm
Complaints and allegations form
Person making the complaint or allegation
PLEASE NOTE: Anonymous reporting is allowed, but providing details is encouraged to aid in the investigation.
Name
First
Last
Your email
Phone
If you entered contact details, do you prefer to be contacted, if necessary, by
Email
Phone
Either
Do you require assistance to participate in the complaint process?
No
Yes - Describe
All complaints or allegations go to HR and the CEO, except as per below. Please indicate:
*
Any Impact staff (except HR or CEO) ⇒ HR
Human Resources ⇒ CEO
CEO ⇒ Impact Board
The agency in general ⇒ CEO
Complaint details
Type of complaint:
Breach of Code of Conduct, Ethics and Professionalism
Bullying
Discrimination
Harassment
Victimisation
Other
Location connected to the complaint
House or program, office, etc.
Name of the person against whom the complain is made, if known
If it is against the agency in general, please type IMPACT
When did the alleged event(s) happen?
Date and time if applicable.
If it is over a period of time, please give the date range.
Details of the complaint
*
Please provide copies of any documents that support the claims in your complaint.
If applicable, how do you think this could be resolved?
*
Supporting Information
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