Note: Fields marked with "*" are required fields.
Describe your complaint, giving us sufficient details to enable us to investigate it.*
Have you discussed your concern with a departmental officer?*
Yes No
If yes, please enter the name and location of the person you have been dealing with.
What do you believe should happen to resolve your complaint?
The following details will help us investigate your complaint and provide you with a response.
Name:
How would you prefer us to contact you?
Phone Email Post
Phone:
Email:
Postal address:
Please advise if you have a disability or other special need:
If it is necessary, do you give consent to provide your personal information to a relevant third party for the purpose of resolving your complaint?
Privacy Statement: The Department of Environment and Resource Management is collecting the personal information on this form for the purpose of investigating and responding to your complaint. Your personal details will not be disclosed to any third party without your consent unless required to do so by law.
Last updated 25 August 2010
