Merseyside Fire & Rescue Authority
Members Code of Conduct Complaints Form
DATA PROTECTION, AUDIT AND COMPUTER MISUSE ACT
Data held is in accordance to the Data Protection Act 1998. This data will be stored
securely at Headquarters and also kept electronically. The data will be processed
for the purposes of dealing with the complaint you have registered. You can gain
access to your data through a subject access request which can be made to:- Corporate
Information Sharing Officer, Merseyside Fire Service Headquarters, Bridle Road,
Bootle, Merseyside, L30 4YD, email: email@example.com
- Please refer to the “Guide to Making a Complaint” when completing this form. This
is available on the website (www.merseyfire.gov.uk) or on request from
Services Section at the address below;
- Your complaint must be submitted in writing – this includes fax and electronic submissions.
If you have any questions or difficulties in filling out this form (e.g. if English
is not your first language OR if you have a disability which makes writing/typing
difficult), please contact the Committee Services on 0151 296 4113 OR e-mail: firstname.lastname@example.org
1. Please provide us with your name and contact details.
Required fields are marked by *
We will not usually reveal your address and contact details unless necessary or
to deal with your complaint.
We will, however, normally disclose your identity to the Member
about whom you are complaining. We will usually also provide such details of your
complaint as necessary and appropriate to be able to
deal with it. If you have serious concerns about your name and a summary, or details
of your complaint being released, please complete section 5 of this form.
2. Please tell us which complainant group refers to you:
Making Your Complaint
Please refer to the “Guide to Making a Complaint”. This gives information on what
you can and cannot complain about what will happen to your complaint once it is
3. Please provide us with the name of the Member(s) /Co-opted Members(s)
you believe have breached the Authority’s approved Members’ Code of Conduct:
4. Please explain in this section (and/or on separate sheets) what the Member(s)/Co-Opted
Member(s) has/have done that you believe breaches the Authority’s approved Members’
Code of Conduct. If you are complaining about more
than one Member you should clearly explain what each individual person has done
that you believe breaches the Code of Conduct.
It is important that you provide all the information you wish to have taken into
account by the audit sub-committee when it decides whether to take any action
on your complaint. For example :
- You should be specific, wherever possible, about exactly what you are alleging the
member said or did. For instance, instead of writing that the member insulted you,
you should state what it was they said.
- You should provide the dates and times of the alleged incidents wherever possible.
If you cannot provide exact dates and times, it is important to give a general timeframe.
- You should confirm whether there are any witnesses to the alleged conduct and provide
their names and contact details if possible.
- You should provide any relevant background information.
Please provide us with the details of your complaint. Continue on a separate sheet
if there is not enough space on this form.
Only complete this next section if you are requesting that your identify is kept
6. In the interests of fairness and natural justice, we believe members who are
complained about have a right to know who has made the complaint. We also believe
they have a right to be provided with a summary of the complaint. We are unlikely
to withhold your identity or the details of your complaint unless there are good
reasons why your identity or details of your complaint should not be disclosed.
Please note that requests for confidentiality or requests for suppression of complaint
details will not automatically be granted. The assessment sub-committee will consider
the request alongside the substance of your complaint.
We will then contact you with the decision. If your request for confidentiality
is not granted, we will usually allow you the option of withdrawing your complaint.
However, it is important to understand that in certain exceptional circumstances,
where the matter complained about is very serious, we can proceed with an investigation
or other action and disclose your name even if you have expressly asked us not to.
Where to send you completed Form and Supporting Evidence to?
Please provide us with details of why you believe we should withhold your name and/or
the details of your complaint (you should refer to Section 5 of the “Guide to Making
a Complaint” leaflet for the criteria that may apply and give evidence
of why you feel that one or more of these criteria may apply.
You should submit your completed form, together with all supporting evidence,
The Monitoring Officer
Merseyside Fire & Rescue Authority
Fax No. 0151 296 4333 � please ensure this is clearly marked for the Attention of the Monitoring Officer
The information collected in the following questions will be separated from your
complaint and will have no bearing on the outcome of the complaint. It will be used
for monitoring purposes only.
We ask you to provide monitoring information to enable us to measure the success
of our equality and diversity policies and to plan for the needs of customers and
service users from all backgrounds
Please tell us which one of the following categories, recommended by the Commission
for Racial Equality, best describes your ethnic origin. If you feel the choices
do not provide a suitable option, please write down how you
would describe your
Do you have a physical or mental impairment which has a substantial and long term
adverse effect on your ability to carry out normal day to day activities?
Religion & Belief