Participant Complaint Form printable pdf download

PARTICIPANT COMPLAINT FORM

Information Sheet

ESSS encourages participants to express concerns or grievances by filing a formal

complaint. Each filed complaint is taken seriously. Reasonable and active steps to address

dissatisfaction and improve the area of concern are taken, wherever possible. Individuals who

file a formal complaint will not face retaliation or barriers to service.

Please take note of the following guidelines:

A Complaint Does Not Include:

1. A request for service;

2. A request for information, documentation, or explanation of policies or procedures;

3. Reports of damage or faulty infrastructure (i.e. uneven foot paths)

4. Reports of hazards (i.e. fallen trees); or

5. Reports concerning neighbouring property (i.e. a noise complaint)

Who Can File a Complaint:

1. A current participant in any program or service.

2. Former participants or visitors using ESSS service.

3. Potential participants waiting to access a program or service.

4. Someone acting on behalf of a participant, provided they have obtained the participant’s

consent.

5. A parent(s)/guardian(s) on behalf of a child participant.

How to File a Participant Complaint:

1. Complaints can be made known to the agency in three ways:

a. The participant can request a Participant Complaint Form and submit it in person

to a staff member or a Program Supervisor.

i. The staff member submits the complaint to his/her Supervisor. The

Supervisor submits the complaint to Executive Director.

b. The participant may print a Participant Complaint Form from

, complete it and mail it to the agency’s mailing address (20618

Eastleigh Crescent, Langley, BC V3A 4C4).

c. The participant may phone the agency’s head office (604-534-2171) where their

complaint will be documented on a Participant Complaint Form by administration

staff.

i. The completed form will then be submitted to the program supervisor and

Executive Director for review.

d. The participant may verbally express a complaint to an employee and have the

employee follow up with their Supervisor.

For information regarding Complaint processing and follow-up procedure call ESSS’ head office

(604-534-2171) or consult Participant Complaint Policy and Procedure located on the agency

website ( )

Participant Complaint Form file location: I:General StaffHR FormsParticipant Complaints

Participant Complaint Form