Merseyside Fire & Rescue Service

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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: foiteam@merseyfire.gov.uk

NOTES:

  1. 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 Democratic Services Section at the address below;
  2. 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: democraticservices@merseyfire.gov.uk

ABOUT YOU

1. Please provide us with your name and contact details.

Required fields are marked by *

Title:
First Name:  
Last Name:  
Address:  
Daytime Tel:  
Evening Tel:
Mobile Tel:
Email Address:    

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 received.

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:

Title Name Council or Authority Name
 

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 confidential.

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.

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.

Where to send you completed Form and Supporting Evidence to?

You should submit your completed form, together with all supporting evidence, to:-

The Monitoring Officer
Merseyside Fire & Rescue Authority
Service Headquarters
Bridle Road
Bootle
L30 4YD

e-mail:democraticservices@merseyfire.gov.uk

Fax No. 0151 296 4333 � please ensure this is clearly marked for the Attention of the Monitoring Officer

Monitoring Information

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

Gender


 

Ethnicity

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 ethnic origin.





 

Disability

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?


 

Sexual Orientation




 

Religion & Belief








 

Age






 

 

 

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