SBC Community Complaint - Rev A

• Completed on

  Date

• Completed by

• Document No.

Complaint Details

• Date and time of complaint

  Date

• Name of person lodging complaint

• Contact detail (for any possible further correspondence)

• Status of person lodging complaint

  Select Local resident General public Shop keeper Council offical Local school Other

  • Local resident
  • General public
  • Shop keeper
  • Council offical
  • Local school
  • Other

• Provide Detail

• Nature of complaint

• Add photos (optional)

  Media

Preventative Actions

• Have strategies been implemented to prevent a re-occurrence?

  Yes

  No

  N/A

• What has been done to prevent a re-occurrence?

• Date preventative actions were implemented

  Date

• Provide reasons

• Add signature

  Sign