Complaints, Concerns, and Compliments

Title *

Type of Feedback *

Complaint

Concern

Compliment

What type of feedback are you providing?

Name *

Complainants are required to identify themselves when making a complaint. Where possible and as appropriate, the Complaints Resolution Officer will maintain confidentiality for both the complainant and persons named in the complaint.

Relationship to BeConnected *

Employee

Contractor

Family Member

Professional Stakeholder

Community Member

Specify your own value:

Phone Number

Email Address

Feedback Category *

Resident Care

Safety

Nutrition

Environment

Community Activity/Liaison

Communication

Attitudinal

Quality of Services

Specify your own value:

What are the specifics of your complaint/compliment? *

Efforts made to remedy (complaints and concerns)

Describe any efforts, if any, you have made to remedy this complaint

For complaints and concerns, what would you like to see changed?

Content Type

Attachments:

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Complaints, Concerns, and Compliments - New Item