Complaints Form

(for example, the person or company that employs you, a business or office providing goods or services, the person or organisation providing your accommodation, a school, TAFE or club)

Name of person/s involved

Business/Organisation name

Their address

Suburb

Their Postcode

Their Telephone

What is their relationship to you?

We need to know:

• what happened?

• where it happened?

• who did it and who was involved?

• why you think it was discrimination?

Please give us all the dates and other details you remember.

For further information please contact the Commission on (08) 9216 3900, 1800 198 149 (country callers only) or TTY (telephone typewriter) 9216 3936, or visit the website www.eoc.wa.gov.au

The Commission encourages non-English speakers to use its services. People wanting to lodge a complaint in a language other than English should call the government’s interpreter service on 13 1450 and ask to be connected to the Commission on 9216 3900.

Were there any witnesses to the events you described? Yes
No

Please attach copies of any documents that may help us with our investigation, such as doctor’s certificates, records of conversations, letters or advertisements.

Upload Document 1

Upload document 2

Upload document 3

Upload document 4

Upload document 5

How has this affected you? What loss or harm have you experienced because of what has happened?

Resolving the complaint. What would you like to happen as a result of lodging this complaint?

Is there anyone who is helping you with this complaint?

What is their name?

What is their role/job?

Helper's address

Helper's Telephone

Helper's Postcode

If you feel you have been discriminated against, you can lodge a complaint with the Commissioner for Equal Opportunity. If you decide to lodge a complaint there are certain things that you, the complainant, need to do. To help you, here is a checklist.

Tick the boxes as you complete each step Your complaint must be in writing, but can be in any language.
You, the complainant, must sign and date your complaint.
Your letter of complaint must refer to a ground of discrimination and an area of activity that is covered by the Act.
You must identify the person and/or organisation who you believe has discriminated against you.
You must explain what happened and why you think it is discrimination. (For example: When did the incident happen? Who were the people involved?)
You must provide any relevant documentation. (For example: A letter of dismissal, medical certificates, statements from witnesses.)
You must lodge your complaint within 12 months of the discrimination. (If your complaint is more than 12 months old, it will only be investigated if you can satisfy the Commissioner that there is good cause why it should be investigated.)

Equal Opportunity Commission

Western Australia

COMPLAINT FORM