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Complaint ID
First Name
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Last Name
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Business Name
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Contact Email
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Phone
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Address
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Address Line 2
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City
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State
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OR
PA
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TN
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UT
VT
VA
WA
WV
WI
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Zip Code
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CS Message
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*
Date Complaint Received
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*
Source of Complaint
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Child/Youth in Care
Community Member
Court Personnel
Current/Former DHR Staff
Educator/School Personnel
Elected Official
Foster/Adoptive Parent
GAL/Attorney
Governor's Office
Law Enforcement
Medical Professional
Out-of-State Agency
Parent/Legal Guardian
Relative/Kinship Caregiver
Service Provider
Complaint Program Area
*
Adult Services
Child & Family Services
Child Care Services
Child Support
Community Services
Food Assistance
JOBS
Other State Agency
Quality Assurance
Resource Management
TANF
Involves Specific Case
*
Yes
No
Investigation Status
Closed
Open
Pending Closure
Under Review
CS Status
Completed
Pending
Submitted for Supervisor Review
Flagged for Pattern
Yes
No
Case Specific Section
Case Status
Open
Closed
Facts ID
*
*
Family/Children Name
*
Open Referral
Yes
No
Nature of Complaint
Nature of Complaint
*
Administrative/Procedural Issues
Case Specific Concerns
Legal/Appeals Issues
Personnel/Professional Conduct
Placement/Licensing Concerns
Administrative/Procedural Issues
Confidentiality Breaches
Delays
Failure to Communicate
Inconsistent Information
Case Specific Concerns
CA/N mishandling
Child Safety
Delayed Services
ISP
Placement Disruption
Safety Plan Issues
Visitation
Legal/Appeals Issues
Due Process
GAL Issues
Parental Rights
TPR Disputes
Personnel/Professional Conduct
Bias
Ethics
Mishandling of Case
Misconduct
Non-Responsive
Retaliation
Rudeness
Visitation
Placement/Licensing Concerns
Abuse in Placement
Cultural Insensitivity
Custody
Licensing Violation
Placement Disruption
Retaliation
Runaway
Visitation
Resolution Summary
Resolution Summary
Duplicate Complaint
Information Provided to Complainant
No Action Taken (Outside Jurisdiction)
Personnel Matter Deferred to Division Head
Referred to County Director/State Office Division
Referred to External Agency
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