CHILD CARE

Specific Allegation(s): Please be objective, specific, realistic, and complete in your complaint. Include Who, What, Where, When, Why: *Anonymous complaints cannot be processed. The identity of the Complainant will not be disclosed during the investigation process; however, the Licensure Bureau cannot ensure anonymity of the complainant. Please tick the following option ( ) Accident/Injury ( ) Health/hygiene ( ) Staffing ( )

Complainant's Name *
Contact Information
Phone
Address
Relationship to facility
Name of authorised officer complaint reported to
Facility Information
Facility Name *
Facility Address
Phone Number
Please tick the following option
 

Specific Allegation(s): Please be objective, specific, realistic, and complete in your complaint. Include Who, What, Where, When, Why:

*Anonymous complaints cannot be processed. The identity of the Complainant will not be disclosed during the investigation process; however, the Licensure Bureau cannot ensure anonymity of the complainant.

I Agree