Complaint

I H S - E T H I O P I A

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Innovative Humanitarian Solutions (IHS)

Fields marked with an * are required

A: Name of the person lodging the complaint

Sex

Age

Address:

Phone:

Email: *

Name of the person you wish to lodge a complaint against (if known):

Date and Time of incident:

Place of incident:

Date and Time of reporting:

B: What is the complaint? (State the nature and key issue of the Complaint)

C: Brief description of the incident or concern

D: Name of witnesses (if any)

E: State what kind of a response you expect from IHS and how you wish to see the matter resolved

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Name of Complainant:

Date

Case referred to:

Date referred:

Name of IHS Staff responding to the Complaints: