How well did we handle your complaint?

We aim to provide a good service in responding to public complaints. In order to help us evaluate our performance in dealing with your complaint we would like you to give us your feedback. We value your comments and would appreciate it if you could complete this questionnaire.

Your Name:

Your Complaint and date (add brief description of subject of your complaint):

Unique Ref (add unique reference number that can be found on complaints correspondence):

Please rate our performance

1. How easy was it to make a complaint?

Please Select Very Poor Poor Satisfactory Good Very Good Excellent

Comments:
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2. How easy were we to contact?

Please Select Very Poor Poor Satisfactory Good Very Good Excellent

Comments:
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3. Did we provide enough help/support?

Please Select Very Poor Poor Satisfactory Good Very Good Excellent

Comments:
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4. How well did we respond to your complaint?

Please Select Very Poor Poor Satisfactory Good Very Good Excellent

Comments:
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5. How well did we keep you informed during the process?

Please Select Very Poor Poor Satisfactory Good Very Good Excellent

Comments:
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6. How clear and understandable were our written and verbal contacts with you?

Please Select Very Poor Poor Satisfactory Good Very Good Excellent

Comments:
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7. Overall, how well did we handle your complaint?

Please Select Very Poor Poor Satisfactory Good Very Good Excellent

Comments:
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8. Do you have any comments or suggestions to help us improve the complaints procedures?

Please Select Yes No

Comments:
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Equalities Information

In order that the Council has a better understanding of the make up of the communities it serves, and the specific needs of people within those communities, we would ask you to complete the form below. The information you provide will be held within the council’s customer relationship management system, and is subject to the Data Protection Act.

Q1. Are you:

Male
Female
Transgender

Q2. To which age group do you belong?

16-18
18-30
30-40
40-50
50-60
60-70
70-80
Over 80

Q3. Do you have any long-standing illness, disability or infirmity? (long-standing means anything that has troubled you over a period of time or that is likely to affect you over a period of time)

Yes
No

Q4. Does this illness or disability limit your activities in any way?

Yes
No

Q5. How would you describe your sexual orientation?

Heterosexual
Gay
Lesbian
Bi-Sexual
Transgender
Prefer not to say

Q6. To which of these groups do you consider you belong to?

White

British
Irish
Gypsy / Roma / Traveller
Any other White background

Black or Black British

Caribbean
African
Any other Black background

Mixed

White & Black Caribbean
White & Black African
White & Asian
Any other Mixed background

Asian

Indian
Pakistani
Bangladeshi
Any other Asian background

Chinese and Other ethnic groups

Chinese
Other ethnic group

Q7. What is your religion or belief?

Christian
Muslim
Hindu
Sikh
Jewish
Buddhist
Other (please state)

Q8. What is your marital status?

Married
Single
Divorced
Civil Partnership
Widowed

Personal details (optional)

Name:

Address:

Telephone number:

E-mail address: