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Complaint Details
Category
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Description
*
Sub-Category-Level 1
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Sub-Category-Level 2
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Have you made a complaint on this issue(s) before?
No
Yes
Has this issue been raised with either your Employer or Safety Rep?
No
Yes
Preferred method of contact
Email
Phone
Are you still employed at this place of work?
No
Yes
Have you made a complaint about bullying to your employer?
No
Yes
Are children at risk?
No
Yes
Is there an Anti-Bullying Policy at your place of work?
No
Yes
Is a person(s) at immediate risk of death/serious injury?
No
Yes
Have you requested a copy of the Anti-Bullying Policy?
No
Yes
In order for the Authority to proceed with a complaint you will be asked to give three or more examples of behaviours, the times and locations of these, and the context for same. Confirmation: I understand that I will be asked to give three or more examples of behaviours, the times and locations of these, and the context for same.
Yes
Employer Details
Organisation
*
Email
*
*
Address 1
*
County
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Address 2
*
Country
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Address 3
*
Eircode
*
Address 4
*
Your Contact Details
Forename
*
Surname
*
Email
*
*
Phone Number
*
Complainant Type
Employee
Member of the Public
Safety Representative
Garda
Other
EU/EEA or Non-EU
EU/EEA or Non-EU
Non-EU/EEA-based
EU/EEA or Non-EU
EU/EEA-based
Site Details
Address 1
*
*
County
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Address 2
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Country
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Address 3
*
Eircode
*
Address 4
*
Consent?
*
