On-line Complaint Form for the consumer or someone acting on their behalf

This On-Line Complaint Form is provided for the consumer or someone acting on their behalf to bring matters of concern to the attention of the Nurses Board of South Australia. This includes:

  • anyone who uses the services of a nurse or midwife;
  • a parent, guardian or representative of someone who uses the services of a nurse or midwife;
  • anyone who is involved in the provision of nursing and midwifery care by a nurse or midwife;
  • a health professional providing care to a client who uses the services of a nurse or midwife.

To make a complaint regarding a nurse or midwife, you may proceed through the following steps to register your complaint on-line or print the form and post to:

The Nurses Board of South Australia
PO Box 2809
Kent Town SA 5071
or fax to: (08) 8 3665599

Alternatively you can lodge your complaint in writing and post to the above postal address. Please ensure that you include the detail requested on the online form.

Copies of de-identified complaints are provided to persons under investigation.

If you need further assistance to fill in the form or have any further enquiries regarding your concerns in relation to a nurse or midwife, feel free to telephone the investigations team during office hours 9-5 on (08) 8366 5544.

Part 1

I would like to bring a complaint to the attention of the Nurses Board of South Australia
on behalf of myself (go straight to part 3)
for someone else

Has the person given you permission to make a complaint on their behalf?

yes
no

Do you have a legal role for the person who you are acting on behalf of? (for example, parent of a child under 18, guardian)
yes, please give details:
No

Part 2

Details of the person who you are making the complaint on behalf of that has concerns regarding a nurse or midwife (if not applicable, go directly to part 3)

First name:

Last (family name):

Address:

Postcode:

Daytime telephone number

Mobile:

Email Address:

Please let us know about any special needs

Interpreter, specify language:
Other, please specify:

Part 3

Details of person completing complaint form

First name:

Last (family) name:

Address:

Postcode:

Daytime telephone number

Mobile:

Email Address:

Preferred contact times:

Part 4

Details of the nurse or midwife (If known)
Details of the name of health service where midwife or nurse is employed?
Address of health service or nurse or midwife

Nature of complaint: (please describe what happened and/or what led to complaint?)

When did it happen? (day, time)

Do you have any relevant documentation in relation to the complaint?

Have you advised or reported this incident to any other agency to action?

No
Yes, if so which one:
Health & Community Services Complaints Commissioner (South Australia)
Aged Care Complaints Investigation Scheme (Department of Health & Ageing)
Other, please specify:

If applicable please give details of contact person you have dealt with from agency or progress of report:


How did you find this form?

from another website, if so give detail:
from the Nurses Board of South Australia website
word of mouth
other:

Part 5

Completion and lodgement

The Nurses Board of South Australia will contact you within 10 working days of receiving your form to let you know we have received your complaint.

Click the SEND button once to lodge your complaint

Thank you for taking the time to notify the Nurses Board of South Australia of your concerns.