Group Water Scheme
Complaint Report Form
(For Use by Members to Bring Complaints to the Attention of the Committee)


1. Member Details
Name: __________________________________________
Address: ________________________________________
Phone Number: _________________________________
Email (if any): _________________________________
Schedule Number (if applicable): _______________


2. Details of Complaint
Date of Incident / Issue: ___________________________
Location (if relevant): _____________________________
Description of Complaint:
(Please provide as much detail as possible, including dates, times, names of individuals involved, and specific concerns)
______________________________________________________________________


3. Supporting Evidence (if any)
(Please list or attach any relevant documents, photos, or other evidence)
______________________________________________________________________


4. Steps Already Taken (if any)
(Please describe any actions you have taken to address this issue prior to this complaint)
______________________________________________________________________

5. Desired Outcome
(Please indicate how you would like this issue to be resolved)
______________________________________________________________________


6. Declaration
I confirm that the information provided above is accurate to the best of my knowledge.

Signed: ________________________________________
Date: __________________________________________





For Committee Use Only
Date Complaint Received: ________________________
Received By: ___________________________________
Reference Number: ______________________________
Action Taken: __________________________________
Date of Resolution / Closure: ____________________