CUSTOMER COMPLAINT FORM
All sections as marked * are to be completed prior to lodging form at Council
All personal details remain CONFIDENTIAL
Complaints will be acknowledged within 5 working day
of receipt and a resolution within 15 days
*Name of person making Complaint
*Residential Address
*Postal Address
*Contact Number/s Email
COMPLAINT DETAILS
Date of Incident (if relevant) Time
Location of Incident
Who/What is the subject of your Complaint
Summary of Complaint/Issue
WITNESS DETAILS (if applicable)
Name
Address Daytime Contact Number
COMPLAINT OUTCOME:
As a result of making this complaint, is there any outcome you would like? Yes ¨ No ¨ If yes, please provide details
Upon signing this form I agree that should legal proceedings be required I will
APPEAR IN COURT AS A WITNESS TO GIVE EVIDENCE TO THE TRUTH OF THIS COMPLAINT
*Complainants name
(signature) (date)
Lodge written Complaint:
- By posting to Port Augusta City Council, PO Box 1704, PORT AUGUSTA SA 5700
- Faxing to (08) 0841 0357
- Emailing to admin@portaugusta.sa.gov.au
F10/2945 – AR11/5432
COUNCIL USE ONLY
INVESTIGATION DETAILS
Name of Person investigating incident
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Customer complaint acknowledged |
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(If no action is to be taken, please explain why)
ACTIONS ARISING FROM INVESTIGATION Date to be completed
Immediate
Further recommendations
INVESTIGATION OFFICER
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Complainant Advised Yes ¨ No ¨ |
Record No AR |
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F10/2945 – AR11/5432
