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Beneficiary Complaint and Feedback Page
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Beneficiary Complaint and Feedback Page
If you are unhappy with the services and activities we provide as MSYD-ASRA or if you have encountered a problem which you want to complain about, please complete this form.
Note: This section is optional however please note that it is more difficult to act on anonymous information
Name of complainant:
Name
Surname
Age:
Sex
Male
Female
Gender Non-conforming
Phone Number:
Please tick the boxes to show what this form is about.
*
Complaint
Feedback
Date of complaint/feedback:
*
Categories of feedback and complaint :
*
Minor dissatisfaction with activities
Major dissatisfaction with activities
Breaches of MSYD’s code of conduct
Allegations of abuse or sexual exploitation by non‐MSYD staff or representatives
Please specify Minor dissatisfaction with activities:
*
lack of follow up
Other
Other
*
Please specify Major dissatisfaction with activities:
*
issues about our program approach
poor‐quality items,
beneficiary selection issues
safety of children/adults being put at risk
Other
Other
*
Please specify Breaches of MSYD’s code of conduct:
*
allegations of inappropriate behavior or misconduct by MSYD staff or partner staff or representatives, including fraud
theft
corruption – such as misappropriation of goods or requests for payment
verbal, physical or sexual abuse
sexual exploitation of beneficiaries
behavior that could be perceived to be abusive
Other
Other
*
Please specify Allegations of abuse or sexual exploitation by non‐MSYD staff or representatives:
*
a member of the community
staff of other NGOs
Other
Other
*
1. Please describe in as mush details as possible the nature of the incident or problem which you are complaining about and how it has affected you.
*
2.Did you notify any of the MSYD-ASRA’s staff members?
*
Yes
No
If yes, did you receive a response from MSYD-ASRA concerning your complaint?
*
Yes
No
3.Please provide any suggestion or positive solution you believe can help resolve the problem.
*
4. Please provide any additional comment you wish the MSYD-ASRA to consider when investigating your complaint.
*
Categories of feedback and complaint :
*
Minor dissatisfaction with activities
Major dissatisfaction with activities
Breaches of MSYD’s code of conduct
Allegations of abuse or sexual exploitation by non‐MSYD staff or representatives
Please specify Minor dissatisfaction with activities:
*
lack of follow up
Other
Other
*
Please specify Major dissatisfaction with activities:
*
issues about our program approach
poor‐quality items,
beneficiary selection issues
safety of children/adults being put at risk
Other
Other
*
Please specify Breaches of MSYD’s code of conduct:
*
allegations of inappropriate behavior or misconduct by MSYD staff or partner staff or representatives, including fraud
theft
corruption – such as misappropriation of goods or requests for payment
verbal, physical or sexual abuse
sexual exploitation of beneficiaries
behavior that could be perceived to be abusive
Other
Other
*
Please specify Allegations of abuse or sexual exploitation by non‐MSYD staff or representatives:
*
a member of the community
staff of other NGOs
Other
Other
*
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