Complaints Lodgement Form

Company

This field is for validation purposes and should be left unchanged.

SECTION 1 - Personal Details

Title*

Name*

Group No*

Student ID*

Email*

Phone*

SECTION 2 – Course / Unit / Module Details

Code/Title*

Date

Section 3 - Complainant Declaration

I have read and understood the Perth College of Business & Technology Complaints Policy and I declare that the other party to the complaint may be contacted in an attempt to resolve the issue.

I agree that Perth College of Business & Technology may conduct independent evaluation checks and that I may be requested to submit further information upon request or attend a meeting to discuss this matter further.

Signature

Use cursor or mouse to sign.

Date

SECTION 4 – Complaint Details

Please tick the following areas to which your complaint relates:

Does your complaint involve another person (e.g. Trainer/Assessor/other student)?*

Yes

If yes, please provide their name:

Does your complaint involve witnesses?*

Yes

Witness Details

If yes, please provide the name/s and contact details of witnesses who are willing to support your claim.

Witness 1 - Name

Witness 1 - Address

Witness 1 - Tel/Mobile

Witness 2 - Name

Witness 2 - Address

Witness 2 - Tel/Mobile

File Upload

Accepted file types: PDF, JPG, JPEG, PNG, DOC, DOCX.

Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 256 MB.

Please outline the nature/circumstances of your complaint:

What actions have you taken, in an attempt to resolve this matter:

What action/resolution would you like to see occur/implemented:

Compliance Manager Use Only

Complaint Form Received - Yes/No

Complaint Form Received - Signature

Complaint Form Received - Date

Complaint Lodgement recorded - Yes/No

Complaint Lodgement recorded - Signature

Complaint Lodgement recorded - Date

Letter of Acknowledgement sent - Yes/No

Letter of Acknowledgement sent - Signature

Letter of Acknowledgement sent - Date

Complaint Forwarded to Director - Yes/No

Complaint Forwarded to Director - Signature

Complaint Forwarded to Director - Date

Note

Use “Complaints Progress Form” to record further actions regarding this Complaint.

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