Complaint Form

Would you like to remain Anonymous?*

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Info

If you selected NO please complete the personal detail questions below.

Name

Address

Phone

Date of Alleged Breach*

Time of Alleged Breach (if Known)

Location of Alleged Breach (if appropriate)

Witnesses of the Alleged Breach (include contact details)*

Please provide details of any City Officers who are involved in the alleged breach*

Briefly outline your complaint*

Do you have any supporting documentation or information that is relevant to your complaint?

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Declaration

NOTE: A person who makes a false or misleading complaint commits an offence (penalty: $5,000).

Code of Conduct – Dealing with Complaints and Allegations Clause 9.3(iv) states: “Any person who has lodged a complaint or any Council Member or employee against whom a complaint has been made, must keep confidential the complaint until the complaint has been determined or finalised.”

I declare that, to the best of my knowledge and belief, the information I have given in this complain is not false or misleading.

I Confirm*

I confirm

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Complaint Form

Declaration

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