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Feedback and Complaints Form

incident formrev

If you have a concern or complaint about your current NDIS support or services provided by Wise Kangroo Care
Support, it’s important to talk about it. Fill out this complaint form below and we will respond to you within 3 business
days.
We will take reasonable steps to ensure that information provided in a complaint and during any complaints process is
kept confidential and only disclosed if required by law or if the disclosure is otherwise appropriate in the
circumstances.
A complaint may be made on an anonymous basis. You can make an anonymous complaint:
(a) by calling us on 0433109903 and stating that you wish to make an anonymous complaint (so we don’t ask you
to identify yourself); or
(b) by filling out this Feedback and Complaints Form but not including your name and the other details in the table
below as these may identify you and post it to 11a Aldridge Ave Plympton park SA 5038.

1. Please provide your details:

Name
Name
First
Last
Client / Family member or friend / Advocate / Carer / Staff Member / Other
2. Are you making this complaint on behalf of a person with a disability?
3. Do you require any help with communication or any other form of support? e.g Interpreter?

4. Incident Type

Settings Event (when behaviour most likely to occur)

Brief Incident Description - please add what / when & where didi it happen?

Strategies used to manage behavior

6. Agreement

I agree that the information included in this Feedback and Complaints Form is true and correct:

Maximum file size: 516MB

7. Rights to access advocates
You may seek support from family, a friend or an independent advocate in making a complaint. If you require
an advocate or representative, please let us know and we would be pleased to cooperate with, and facilitate
arrangements for, advocates (including independent advocates) and other representatives.
8. How to make a complaint to the NDIS Commission
A complaint can be made to the NDIS Commission by:
● Phoning: 1800 035 544 (free call from landlines) or TTY 133 677. Interpreters can be arranged.
● National Relay Service and ask for 1800 035 544.
● Visiting https://www.ndiscommission.gov.au/about/complaints and completing a complaint contact
form.
The NDIS Commission can take complaints about:
● services or supports that were not provided in a safe and respectful way
● services and supports that were not delivered to an appropriate standard
You can make a complaint to the NDIS Commission on an anonymous basis.
9. More information
● Fact sheet: How to make a complaint
● Video: Understanding complaints
The NDIS Complaints Management Resolution Guidance provides more detailed information about the NDIS
Commission’s complaints process.