Ombudsman - Submit a Complaint

Contact Information

Last Name:

First Name:

Initials:

Mailing Address:

Location if different from above:

Telephone:

Home:

- extension:

Office:

- extension:

Email Address:

Language Preference:

English
French

How would you like us to contact you?*
(* Please note, if you wish to communicate via email, the Office cannot guarantee confidentiality.)

Work Telephone
Home Telephone
E-mail
Mail

What is the best time to contact you?

If you are in the Military, please complete the following section.

Military:

Current CF Member
Applicant to CF
Former CF Member

Establishment:

Regular

Reserves

If you are a civilian, please complete the following section.

Civilian:

Current DND employee
Cadet
Family Member
Non Public Fund employee
Former DND employee
Other

Section:

If you are a family member, please complete the following section.

Relationship:

Subject of Complaint:
Approximate Date of Incident: (If Applicable)
Location of Incident: (If Applicable)
What Steps have you Taken:	Military Redress of Grievance Civilian Redress of Grievance Harassment Complaints Process Other, specify : None
Please summarize your complaint below (i.e. incident(s), dates, parties involved, etc.) any steps you have taken to try to resolve it and the outcome in the box below. (approximately 400 words)


Have you ever submitted a complaint to this Office before?
Yes No
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