Complaint Form
COMPLAINT FORM
Please complete this form to submit a complaint
Complainant’s Name (Please print): ________________________________
Address: ___________________________________________________
Phone Number: _______________________________
Email Address: ________________________________
1. What is your issue regarding? (Please select one)
□ By-law Issue
□ Cemetery Issue
□ E-payments and E-filing □ Elected Officials
□ Employee
□ Fire and Emergency Services Issue (Non-emergency)
□ Garbage/ Recycling
□ Park/ Field/ Tree Issues □ Parking Lot Maintenance Issues
□ Road/ Sidewalk Maintenance Required
□ Streetlight Out
□ Traffic Light/ Street Sign Problem
□ Water Issues □ Other __________________________________________
2. Can you provide an image of the issue? (Please attach image to this form)
□ Yes
□ No
3. Please provide details regarding the complaint (i.e. When did this happen, who
was involved, what was said, etc.) ________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________
________________________________________________________
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4. Where is the problem located, if applicable (i.e. nearest address or intersection)? ________________________________________________________
________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________
5. Is this an ongoing issue?
□ Yes □ No
6. Declaration (Please check & sign) □ I declare that the information as provided by me on this Complaint Form is true
and correct to the best of my knowledge.
_______________________________ _____________________
Signature Date
The personal information collected on this form is collected under the authority
of the Municipal Act, 2001, as amended and will be used solely for the purposes
related to the complaint, the investigation and subsequent report therein.
Questions about this collection should be addressed to the Town Clerk, 519-688-3009 Ext. 3224.