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Municipal Complaint Form
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municipal complaint form public
By-Law No. 64-2017
How to make a complaint
The Township of North Stormont Clerk’s Department has procedures for receiving and handling complaints from citizens who are dissatisfied with service, actions or lack of action by a Township department or staff member. We recommend you first speak directly with the service area where you have an issue, in person or by telephone. Most complaints are received verbally and can be resolved promptly by the department in charge of the service.
If you are not satisfied with how your verbal complaint is handled you can submit a written complaint by completing this form which is available on any of our websites associated with
www.northstormont.ca
Date of complaint submission:
Complainant contact details
Name
First name:
Last name:
Email:
(considered the most prompt way we can communicate with you)
Mailing Address
Mailing address:
City/Town:
Province:
Postal code:
Note: If only a mailing address is provided our response timelines may be extended.
Phone number:
Note: We only call if we require clarification.
Complaint type
Complaint type
Access of services
Facilities
Outcome of existing complaint
Processes or procedures
Programs
Staff conduct
Timeliness of service
Other
Summary of complaint
Complaint summary
Please record information on what happened, who was involved, dates, and times. Be as detailed as possible. If there is not enough space to describe the complaint, attach extra documents.
Add an attachment
Maximum 3 files.
10 MB limit.
Allowed types: pdf, doc, docx.
Service area / location of problem:
Staff persons involved (if known and applicable):
List of enclosures (include copies of any documentation in support of the complaint):
Resolve
Resolution
How do you suggest the complaint be resolved?
I solemnly declare that all the statements contained in this submission and all the supporting documents are true.
I solemnly declare that all the statements contained in this submission and all the supporting documents are true.
Timeline
Clerk’s Department staff will contact you to acknowledge this complaint in the next 1 to 5 business days after receiving this completed form. The Clerk’s Department will forward the complaint on to the Investigating Staff Employee who will respond within 30 days of receipt of this complaint. If this is not possible, you will be contacted and given a reason why this timeline is being adjusted.
Notice of collection
The personal information you choose to provide on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). The information you provide will be used to investigate the complaint and may be used for contact purposes but is otherwise considered confidential. Questions about this collection can be directed to the Clerk’s Department, Township of North Stormont,15 Union Street, Berwick, ON, K0C 1G0,
clerk@northstormont.ca