Docstoc

Complaint Template - Excel

Document Sample
Complaint Template - Excel Powered By Docstoc
					          DISABILITY SERVICES COMMISSIONER ANNUAL COMPLAINTS REPORT (ACR) 2009-2010
                                                           GUIDELINES FOR COMPLETING COMPLAINTS REPORT
                               This template has been developed to assist disability service providers in their reporting requirements under section 105 of the Disability Act 2006.

                                       This report template comprises of two pages (or tabs). PAGE 1 (this page) - 'Guidelines for completing the complaints report' and PAGE 2 - the 'Complaints
                                       Report' that requires completion.
   USING THIS REPORT TEMPLATE
                                       To move between pages click on the PAGE TABS at the BOTTOM LEFT hand side of the screen titled 'Page 1' and 'Page 2'.

                                       All fields marked with '*' disability service providers are required to complete; disability service provider name; Complaint outcome - category; Complaint
                                       outcome - description; and Complaint status - resolution.

               Page 1 - Guidelines TIP - Hold your mouse over the red triangles               for 'tool tips' and definitions and use these guidelines to help you fill in your Complaints Report on page 2.

                                       TIP - There are 26 columns in this report, scroll right across to ensure you have completed all the required fields. If you have no complaints to report, remember
      Page 2 - Complaints Report to submit a 'Nil Return'.
                                       Step 1 - Choose 'YES' from the drop down menu in Cell C1 (page 2)
      How to submit a NIL Return                                       Step 2 - Enter your Service Provider Name in Cell A3 (page 2)
                                                                                                        Step 3 - Submit report

                         Definitions Service User - The person with the disability receiving the service.

                                       Complainant - The person who raises the complaint. This may be the service user or a person raising the complaint of their behalf.

                                       Complaint - An expression of dissatisfaction that arises out of the provision of a disability service; or out of the complaints handling process itself, where a
                                       complaint is that a registered disability service provider has not properly investigated, or not taking proper action, upon receiving a complaint. (s.109 Disability Act
                                       2006; Australian Standard ISO 10002: 2004 MOD)


               REPORT DUE DATE: FRIDAY 9 JULY 2010 (this includes 'NIL' returns)

             SUMBIT REPORTS TO: acr@odsc.vic.gov.au



            FIELDS                                               GUIDELINES FOR COMPLETION of ANNUAL COMPLAINT REPORT on Page 2

* DISABILITY SERVICE
                                       Free text: Enter your registered disability service provider name.
PROVIDER


COMPLAINT NUMBER                       Free text: Enter a complaint reference number or identifier for each complaint.


SERVICE OUTLET                         Free text: Enter the name of the facility or specific service outlet for each complaint.


REGION                                 Drop box: Select the region where the service outlet is located.


SERVICE TYPE                           Drop box: Select the name of the funded service activity which is subject to the complaint.


LOCAL GOVERNMENT AREA
                                       Drop box: Select the local government areawhere the service outlet is located.
(LGA)


SOURCE OF COMPLAINT                    Drop box: Select the source of the complaint from the categories provided.


NAME OF COMPLAINANT                    Locked field: Information not sought 09/10.


ADDRESS OF COMPLAINANT                 Locked field: Information not sought 09/10.


COMPLAINANT CONTACT                    Locked field: Information not sought 09/10.


SERVICE USER CULTURAL
                                       Drop box: Select Aboriginal, Torres Strait Islander or other cultural identity.
IDENTITY


SERVICE USER NAME                      Locked field: Information not sought 09/10.


                                       Drop box: Select the age range which best corresponds to the actual or approximate chronological age of the person with a
SERVICE USER AGE RANGE
                                       disability affected by the complaint.


SERVICE USER GENDER                    Drop box: Select the gender or 'sex' of the person with a disability affected by the complaint.


SERVICE USER DISABILITY
                                       Drop box: Select the type of disability as defined in Disability Act 2006.
TYPE


ISSUE / COMPLAINT CATEGORY             Drop box: Select the principal complaint or most serious issue only.


COMPLEXITY OF COMPLAINT                Drop box: Select the ease or difficulty involved in resolving the complaint.


COMPLAINT DESCRIPTION                  Free text: Enter a brief description of the significant issue(s) raised by the complainant.


OUTCOME SOUGHT BY
                                       Drop box: Select the outcome which the complainant is seeking to resolve the principal or most serious issue.
COMPLAINANT


DATE COMPLAINT RECEIVED                Free text: Enter the date (dd/mm/yy) that the complaint was received.


'IMPORTANT TO' FACTORS                 Free text: Enter the factors that are 'important to' the service user for the resolution of the complaint.


'IMPORTANT FOR' FACTORS                Free text: Enter the factors identified that are 'important for' the person in resolution of the complaint.


* COMPLAINT OUTCOME -
                                       Drop box: Select the outcome of complaint.                      Leave field blank if the complaint still open.
CATEGORY

* COMPLAINT OUTCOME -
                                       Free text: Describe the outcome(s) achieved to resolve or close the complaint.                                   Leave field blank if the complaint still open.
DESCRIPTION

* COMPLAINT STATUS /
                                       Drop box: Select where the complainant was 'satisfied' or indicate where the unresolved complainant was referred for review.
RESOLUTION


DATE COMPLAINT RESOLVED                Free text: Enter the date (dd/mm/yy) that the complaint was closed.


TIME TAKEN                             Drop box: Select the period of time it took to follow up and resolve or close the complaint.


COMMENTS / ADDITIONAL
                                       Free text: Use this to enter any comments or details eg.multiple issues/ multiple outcomes.
DETAILS
                                                                   DISABILITY SERVICES COMMISSIONER ANNUAL COMPLAINTS REPORT (ACR) 2009/2010




Is this a NIL Return?
        If YES enter 'YES' in cell C-E1
                                                                                                                                                                             SERVICE                     SERVICE            SERVICE
 * DISABILITY               COMPLAINT     SERVICE
                                                                               LOCAL
                                                                                         SOURCE OF   NAME OF    ADDRESS OF COMPLAINANT                                                  SERVICE
                                                                                                                                                                                                                   SERVICE              ISSUE / COMPLEXITY
                                                                                                                                                                              USER                        USER                USER
   SERVICE                                          REGION   SERVICE TYPE   GOVERNMEN                                                                                                                               USER              COMPLAINT     OF
                             NUMBER        OUTLET                                        COMPLAINT COMPLAINANT COMPLAINANT   CONTACT                                        CULTURAL   USER NAME           AGE             DISABILITY
   PROVIDER                                                                 T AREA (LGA)                                                                                                                           GENDER              CATEGORY COMPLAINT
                                                                                                                                                                            IDENTITY                      RANGE               TYPE
                                                                                                      Locked field:            Locked field:            Locked field:                   Locked field:
                                                                                                 Information not sought   Information not sought   Information not sought              Information not
                                                                                                         08/09.                   09/10.                    09/10.                      sought 09/10.
                                                   DISABILITY SERVICES COMMISSIONER ANNUAL COMPLAINTS REPORT (ACR) 2009/2010




                                         DATE                                                                                               DATE
                          OUTCOME                                                    * COMPLAINT                           * COMPLAINT
COMPLAINT DESCRIPTION    SOUGHT BY
                                      COMPLAINT   'IMPORTANT TO'   'IMPORTANT FOR'                 * COMPLAINT OUTCOME -                 COMPLAINT TIME    COMMENTS / ADDITIONAL
                                                                                      OUTCOME -                             STATUS /
                                       RECEIVED      FACTORS           FACTORS                          DESCRIPTION                       RESOLVED TAKEN          DETAILS
                        COMPLAINANT                                                   CATEGORY                             RESOLUTION
                                       dd/mm/yy                                                                                          dd/mm/yy

				
DOCUMENT INFO
Description: Complaint Template document sample