Chief Constable Complaint Form

SECTION 1 EQUALITY OF SERVICE MONITORING FORM

We want to make sure everyone has an equal chance to use and benefit from our services. To ensure we continue to do this, it would help us if you could answer the following questions. If you prefer, you do not have to answer these questions as it will not affect your complaint in any way.

The information provided in this form may be used by public bodies involved in the police complaints system, including the police and IOPC. You can find out how your personal information will be used in the privacy notices found on the website of each organisation.

Please mark all the answers that apply with an ‘X’.

Sex

Female
Male
Intersex
Other (please give details)

Is your gender different to the gender you were assigned at birth?

Yes
No
Don't know

If yes, please state the gender you were assigned at birth:

Sexual orientation

If sexual orientation is "other" please enter here

Do you have a physical or mental impairment that has a substantially adverse and long-term effect on your ability to carry out normal day-to-day activities?

Yes
No
Don't know

If you have answered 'yes' to the question above, which option below describes your disability?

Ethnicity

If "Other" Ethnicity selected, please specify below

Religious belief/faith

If "Other" Religion selected, please specify below

Pregnancy and maternity

Pregnant
On maternity/paternity/adoption leave
Returning from maternity/paternity/adoption leave
None of the above

Section 2 - About you

Title *

Name *

First

Last

Please provide at least two forms of contact below.

Address Line 1

Address Line 2

Town/City

County

Postcode

Email

Telephone

Are you making a complaint on behalf of someone else?

Yes
No

Section 3 – Details of person on whose behalf you are complaining

Do not complete this section, if you are making a complaint against PCC staff on your own behalf.
If you are making a complaint on behalf of someone else, you must have permission from that person.

What is your relationship to the person making the complaint?

Checkboxes *

I confirm I have received permission to act on the named individual’s behalf

Title *

Name *

First

Last

Please provide at least two forms of contact below.

Email

Telephone

Section 4 – Your complaint

Please outline the details of your complaint. Please describe the circumstances that have led to your complaint. Include details of:

• Who was involved?
• What was said and done?
• Summary of your complaint

Please explain what you would like to happen. What is your intended resolution for your complaint?

Section 5 – Confirmation that information provided is correct

I can confirm the information I have provided is truthful and accurate to the best of my knowledge and I have read and understood the privacy notice.

Tick to confirm the above statement.

Name *

First

Last

Date *

Section 6 – Feedback

We are constantly striving to improve our service. Please tell us if you have any feedback below.

Using this form

Accessibility

What happens to the information in my complaint form?

SECTION 1 EQUALITY OF SERVICE MONITORING FORM

Section 2 - About you

Section 3 – Details of person on whose behalf you are complaining

Section 4 – Your complaint

Section 5 – Confirmation that information provided is correct

Section 6 – Feedback