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Complaints, Comments and Compliments Form

If you prefer not to fill in this form online, then please use the form provided below and return it to; Complaints, Comments & Compliments, Customer Services, Powys County Council, County Hall, Llandrindod Wells, LD1 5LG

Complaints, Comments and Compliments form.

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View our Corporate Complaints Policy for Additional Guidance and Information on Complaints and what you can do if you are not satisfied with our response.

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Privacy Statement

Powys County Council accepts the following responsibilities for personal information recorded through this web page:-

The information will only be used for the agreed reason and will be looked after securely
The information will only be kept for as long as needed or to comply with statutory requirements and will then be securely destroyed
If the information has to be shared with other agencies initial consent will be gathered at this point and explicit (signed) consent will obtained by the service / department concerned as soon as possible. Unless we are obliged by law to disclose the information.

Detailed guidance can be found on our Freedom of Information Web pages or from the Information Management Team.

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Personal Details:
This form will be sent to haveyoursay@powys.gov.uk
Name:
Address:
Daytime Phone Number:
Evening Phone Number:
Email Address:
Date:
What is your preferred language for communication?WelshEnglish
Nature Of Your Enquiry:
Do you class this enquiry as:A comment - where you do not expect an individual responseA complaint - requiring an individual responseA Compliment
Is this enquiry regarding:
Equalities
Schools
Children and Families (former Children’s Social Services) and Social Care (former Adult Social Care)
Other
Details of Your Enquiry:
Please give a brief summary of your enquiry. Please include locations, dates, witnesses and any other information which you feel may be of benefit:
Have you already had contact with the council about this matter? If so, with whom and where was the contact made?
What would you like us to do about this matter?
Where a complaint is made against an officer(s) then ordinarily it will be impractical to fully investigate the complaint without the officer(s) being aware of your identity and the nature of your complaint: If for any reason you would not wish your identity to be revealed to the officer(s) concerned, please indicate this by ticking the box, and set out your reasons below.
Withhold details:
Reason:
Equal Opportunities Monitoring Form
All questions are optional. Please leave blank any that you prefer not to answer.
Powys County Council is committed to providing services which meet the needs of different types of people and to remove any barriers that exist. To achieve this, we need to gather information about who uses our services, and whether their needs are met. This will then assist in shaping the way that we design, manage and improve our services. We would therefore appreciate you taking just a few minutes to complete this information as part of that process.
All the information that you give us here, will be treated in the strictest of confidence, and, will be used only to provide data for statistical analysis and reporting.
1. Gender
What is your gender?MaleFemale
2. Age
What is your age?Under 1616 – 1718 – 1920 – 2425 – 3435 – 4445 – 5455 – 6465 – 7475 or over
3. Disability
Do you have any physical or mental health conditions, illnesses or impairments, lasting, or expected to last, 12 months or more?
YesNoDon’t know
If you answered ‘Yes’ above -
Does your condition, illness or impairment reduce your ability to carry out day-to-day activities?
Yes-a lotYes-a littleNot at all
Do you have any health conditions, illnesses or impairments which affect you in the following areas?
Please choose ALL that apply;
Vision (for example blindness or partial sight)
Hearing (for example deafness or partial hearing)
Mobility (for example walking short distances or climbing stairs)
Dexterity (for example, lifting and carrying objects or using a keyboard)
Learning or understanding/concentrating (for example associated with Dyslexia or Down’s syndrome)
Memory
Mental Health
Stamina or breathing or fatigue
Socially or behaviourally (for example, associated with autism, attention deficit disorder or Asperger’s syndrome)
Other
If other - Please describe
4. Pregnancy and Maternity IF FEMALE:
Are you pregnant, or have you given birth within the past 26 weeks?NoYes - I’m pregnantYes - I’ve given birth within the past 26 weeks
5. Language
What is your main language?EnglishWelshOther
Please specify if you have selected " Other language"
Can you understand, speak, read or write Welsh?
Please choose ALL that apply
Understand Spoken Welsh
Speak Welsh
Read Welsh
Write Welsh
None of the above
6. National Identity
How would you describe your national identity?
Please choose ALL that apply.
Welsh
English
Scottish
Northern Irish
British
Irish
Polish
Other
If other - Please describe
7. Ethnicity
What is your ethnic group? Please choose JUST ONE of the 18 options below that best describes your ethnic group or background.
WhiteWelsh/English/Scottish/British/Northern IrishIrishGypsy or Irish TravellerAny other White background
If other - please describe
Mixed/Multiple ethnic groupsWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed/Multiple ethnic background
If other - please describe
Asian/Asian BritishIndianPakistaniBangladeshiChineseAny other Asian background
If other - please describe
Black / African / Caribbean / BritishAfricanCaribbeanAny other Black/African/Caribbean background
If other - please describe
Other Ethnic groupArabAny other ethnic group
If other - please describe
8. Sexual Identity IF AGED 16 OR OVER:
Which of the following best describes how you think of yourself?Heterosexual or StraightGay or LesbianBisexualOtherPrefer not to say
9. Marital or same-sex Civil Partnership Status IF AGED 16 OR OVER:
What is your current marital or same-sex civil partnership status?Single (that is; never married and never registered in a same-sex Civil Partnership)MarriedIn a registered same-sex Civil PartnershipOther
If other - Please describe

Complaints, Comments and Compliments Form

Personal Details:

Nature Of Your Enquiry:

Details of Your Enquiry:

Equal Opportunities Monitoring Form

Privacy Statement