Electronic Complaint Form

Please use this form to make a complaint about a State Government department or agency, local government or university.

For information on what you can and cannot complain about go to ‘How to make a complaint’ or contact us on (08) 9220 7555 or 1800 117 000 (toll free for country callers) for assistance.

The information you provide will only be used for the purpose of assessing and investigating your complaint.

Entries marked with * must be completed.

Who is your is complaint about

Your Contact Details

Please provide us with your contact details below. Please note that your name and address must be provided in order to submit your complaint.

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Representative's Contact Details

If you want someone to represent you regarding your complaint, please give us their contact details below.

Do you require help to access our services?

Do you have an ongoing disability that means you require assistance to access our services?

     


Do you need a translator?


 

How did you find out about the Ombudsman?

Please choose an option from the list below:














Tell us about your complaint

Have you made a complaint to the agency you are complaining about? *

Supporting documentation

If you want to send a relevant document, you can attach a document to this form or send it by post, email or fax:


I will be sending relevant documents that support my complaint by:

Other information about you

By filling in this information, you will be helping us ensure our services are available to all of the Western Australian community. The personal information you provide is confidential to our office. Any information we release will only identify groups to analyse access by different members within the community. The analysis will not provide any information about individuals. While we would appreciate your responses, you are not required to fill in this part of the form.
Gender:

    

Are you of Aboriginal or Torres Strait Islander origin?

      

What is the primary language spoken at home?

   

Do you have an ongoing disability?

      

If yes, please indicate what your disability involves:


      





Submit your complaint

Please check that the details are correct before submitting your complaint.

If you have not provided mandatory information, you will receive an error message and can use the back button/arrow on your Internet Browser to return to this page.

To clear all information, click on the 'Reset' button.

If you are satisfied with your submission, click on the 'Submit' button to send us your complaint.