Make a Complaint

As Gaeilge

Name:*

Address:*

County:*

Contact number:*

Email:*

The Office is open from 9.15am to 5.00pm. What is the best time to contact you?:*

How did you hear about our Office?*

Are you a young person making complaint about something that affects you? Yes No

If yes, please give your date of birth*

If no, please give the name(s) and age(s) of child(ren) you wish to make a complaint for:*

Please state your relationship to the child(ren), for example, parent, guardian, teacher, social worker, aunt, uncle, brother etc.:*

If possible, please say what are the views/wishes of the child(ren) concerned on what you wish to complain about*

What organisation or service is your complaint about?*
for example a school, a hospital, a local authority

Who have you dealt with at the organisation or service you’re complaining about?*
for example Board of management of school, people wokring in the Consumer affairs section of the HSE

Please explain your complaint and what you have done to try to sort it out?*

Did you ask anyone to deal with your complaint? If so, what happened?

Why do you think the organisation’s actions are unfair?*

Please say how these actions have affected:*
- You, if you are the child/young person making the complaint for yourself
- the child/young person you are making the complaint for

What would you like to see happen?*

Have you made this complaint already to another organisation or have you taken any legal action? If so, please give information:*

If you have any more information you’d like to tell us please put it here:*

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