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Complaints Management Form

Register No (office use):

Dear Participant:

We appreciate your input to further assist us in improving our service quality.  Please complete the following form in the unfortunate event of any complaint.

A formal investigation will commence once we receive the completed form. If you require assistance in the completion of this form, please contact us with provided details. Please send the information to:

Email: info@cosmosdivinecare.com.au

and/ or

Contact Us: 1800 953 997

Anonymous feedback/ complaints are accepted.

Please email details of your feedback/ complaint anonymously to info@cosmosdivinecare.com.au

You may provide as much detail as you wish and may use this form amended to your discretion.

Alternatively, you may raise/ escalate your complaint directly to the NDIS Commission by:

  • Phone: 1800 035 544 (free call from landlines) or TTY 133 677.
  • Interpreters can be arranged. Call TIS National on 131 450.
  • National Relay Service and ask for 1800 035 544.
  • Completing a complaint contact form at the NDIS Quality and Safeguards Commission website.
SECTION – COMPLAINT DETAILS (TO BE COMPLETED BY PARTICIPANT OR PARTICIPANTS FAMILY)
Date of Incident
Date of Report
Write details of incident and complaint here.
Date:

IMMEDIATE ACTION (TO BE COMPLETED BY SERVICE PROVIDER)

Immediate actions and measures were satisfactory?
Identified Root Cause for the Complaint

REQUIRED ACTIONS

Outcome of Complaint
Status of Complaint

NOTIFICATION

NDIS consultation required?
Complaint resolved?
Results communicated with Participant?
Date of NDIS Consultation

Sign off

Date: