Workplace Complaint Form
You can remain anonymous; however, this may limit any follow up action.
What information do I need to provide?
When completing this form, you will be asked to provide the following information:
- the date/s and time/s of the behaviour;
- a detailed description of the behaviour;
- who engaged in the behaviour;
- who may have witnessed the behaviour;
- any supporting documentary evidence (such as emails, text messages, file notes, images etc.)
- the outcome you are seeking; and
- any steps taken to resolve or address the matter.
A PWSS Case Coordinator can assist a person to complete the form, however the individual will be required to review and confirm the contents of the form are accurate.
You may also be asked to provide further information as part of the preliminary assessment process.
Something has happened but I do not want to submit a formal complaint. What can I do?
If you want to report an incident so it is on record but do not want any further action taken, you can still complete and submit this form but note your desired action in the relevant outcome section – for example, ‘I want to have this matter on record but I don’t want any further action taken by the PWSS at this time.’
If you are primarily seeking support in response to an incident and do not want to report it, the PWSS Case Coordination Team are best placed to assist and can be contacted by emailing support@pwss.gov.au or calling
1800 747 977 (option 1).
What will PWSS do with a workplace complaint report?
This report will ask you to provide personal information to the PWSS. Your personal information is protected by the Privacy Act 1988.
The PWSS collects and uses your personal information to facilitate the local resolution process, assess and manage reports (or complaints) about serious incidents and misconduct including workplace conflict that amounts to a work health and safety risk, as well as providing support and education to Commonwealth parliamentary workplace participants.
The PWSS will only disclose your personal information with your consent, except as required by law.
If you choose not to provide some or all of your personal information, we may not be able to respond to your complaint or contact you to provide support.
For more information about how the PWSS will handle your personal information see our Privacy Policy.
Declaration and consent
By submitting this form to the Parliamentary Workplace Support (PWSS), I declare that:
I consent to the PWSS collecting, using, and disclosing my personal information for the purposes of:
- Providing support to me in relation to serious incidents and misconduct, including workplace conflict.
- Receiving and managing my report (or complaint).
- Assessing my eligibility for resolution through the PWSS.
- Where applicable, referring my report for workplace review.
- Providing referrals.
I understand that, if I do not consent to the above, this may limit the PWSS’ ability to help me seek resolution through the PWSS or to contact me about my complaint.
I acknowledge that the PWSS may share information about my complaint, for the purposes of undertaking an assessment of my complaint and/or resolving my complaint.
I confirm that, to the best of my knowledge, all of the information I have provided in this application is true, complete, correct and not misleading by inclusion or omission.
I understand that giving false or misleading information is a serious offence under the Criminal Code Act 1995.