Sample Complaint Register Template
Complaint # Time received Received by
Date received Medium (phone/letter/fax/ e-mail/in-person) Date acknowledged
CUSTOMER INFORMATION Complainant's Name Address City, Prov., Postal Code Phone Account /Policy/ Customer #
E-Mail Address COMPLAINT DETAILS Date problem occurred Business line? Complaint concerns which: Product or service? Person/dept.?
Nature of complaint:
What customer wants done:
Outcome (e.g., agreement reached, partial agreement, no agreement, referred, declined, withdrawn)
Date of final position letter to client
Approved by/signature