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Complaints investigation referral form
Complaints investigation referral form
Complaints investigation referral form
LA Case Reference
(Required)
Name of Local Authority
(Required)
Referrer / Point of Contact
Phone
Service Required
(Required)
Stage 2 Complaint
Stage 3 Complaint
STAGE 2 COMPLAINT
Service required
Independent Person
Investigating Officer
STAGE 3 COMPLAINT
Service required
(Required)
Chair
Panel Member
Panel Member
COMPLAINT DETAILS
Complaint formally accepted on
(Required)
Stage 1 Complaint / SoC (referrals cannot be accepted without this)
(Required)
Drop files here or
Select files
Max. file size: 15 MB.
the date the complaint was accepted by the Local Authority for this stage of the complaint
Report Final Filing date
(Required)
(55 working days from escalation unless exception)
Any other dates
PANEL DETAILS
Type of Panel
In-person
Online
Date of Panel - Preference 1
(Required)
Date of Panel - Preference 2
(Required)
Date of Panel - Preference 3
Special Requests
Risks to IP
Young Person's details -1
Gender
(Required)
Male
Female
Non-binary
Agender
My gender is not listed
Prefer not to answer
Ethnicity
(Required)
Asian or Asian British - Any other Asian background
Asian or Asian British - Bangladeshi
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Black or Black British - African
Black or Black British - Any other Black background
Black or Black British - Caribbean
Mixed or Mixed British - Any other Mixed background
Mixed or Mixed British - White and Asian
Mixed or Mixed British - White and Black African
Mixed or Mixed British - White and Black Caribbean
Not Disclosed - Did not wish to reply
Not Disclosed - Form not completed
Other Ethnic Group - Any other ethnic group
Other Ethnic Group - Chinese
White - Any other White background
White - British
White - European
White - Irish
unknown
Age
(Required)
Care Status
(Required)
Section 17 (child in need)
Section 17 (child protection)
Section 20 (accommodated)
Section 31 (full care order)
Section 38 (interim care order)
Care leaver
Relevant child
Former relevant child
Qualifying care leaver
Young Person's details -2
Gender
Male
Female
Non-binary
Agender
My gender is not listed
Prefer not to answer
Ethnicity
Asian or Asian British - Any other Asian background
Asian or Asian British - Bangladeshi
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Black or Black British - African
Black or Black British - Any other Black background
Black or Black British - Caribbean
Mixed or Mixed British - Any other Mixed background
Mixed or Mixed British - White and Asian
Mixed or Mixed British - White and Black African
Mixed or Mixed British - White and Black Caribbean
Not Disclosed - Did not wish to reply
Not Disclosed - Form not completed
Other Ethnic Group - Any other ethnic group
Other Ethnic Group - Chinese
White - Any other White background
White - British
White - European
White - Irish
unknown
Age
Care Status
Section 17 (child in need)
Section 17 (child protection)
Section 20 (accommodated)
Section 31 (full care order)
Section 38 (interim care order)
Care leaver
Relevant child
Former relevant child
Qualifying care leaver
Young Person's details -3
Gender
Male
Female
Non-binary
Agender
My gender is not listed
Prefer not to answer
Ethnicity
Asian or Asian British - Any other Asian background
Asian or Asian British - Bangladeshi
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Black or Black British - African
Black or Black British - Any other Black background
Black or Black British - Caribbean
Mixed or Mixed British - Any other Mixed background
Mixed or Mixed British - White and Asian
Mixed or Mixed British - White and Black African
Mixed or Mixed British - White and Black Caribbean
Not Disclosed - Did not wish to reply
Not Disclosed - Form not completed
Other Ethnic Group - Any other ethnic group
Other Ethnic Group - Chinese
White - Any other White background
White - British
White - European
White - Irish
unknown
Age
Care Status
Section 17 (child in need)
Section 17 (child protection)
Section 20 (accommodated)
Section 31 (full care order)
Section 38 (interim care order)
Care leaver
Relevant child
Former relevant child
Qualifying care leaver
Other details
Name of complainant
Relationship to Child
Phone
Has the child been notified of the complaint?
Yes
No
No - the complainant is the child
Please provide brief details of the complaint
Action already taken
Outcome sought by complainant
Details of any other professional already appointed for this complaint
Name / Role / Email / Phone
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