FORMULAIRE DE PLAINTE - Ville de Gatineau

Gatineau Ombudsman’s Office25 rue Laurier, 5 th FloorP.O. Box 1970, Station HullGatineau QC J8X 3Y9Telephone: 819-595-4141Fax: 819-243-2362E-mail: ombudsman@gatineau.caREQUEST FOR INTERVENTIONMission of the Ombudsman’s OfficeThe mission of the Gatineau Ombudsman’s Office is to intervene when Gatineau or its representative has:‣ acted in a manner that is unreasonable, unfair, abusive or discriminatory;‣ failed to fulfil its duty, or has shown evidence of misconduct or negligence;‣ when exercising its discretionary authority, acted unfairly, basing itself on arguments that are not relevant or failing toprovide its reasons when it should have.Identification of the individual, group or association making the request (mandatory information)Individual’s last name:Individual’s first name:Group or association:Address:City: Province: Postal code:Telephone: Home: Other: Fax:E-mail:Description of the request1. Please summarize your complaint (you may include additional pages and any relevant documents) and set out inchronological order the steps you have taken to date to attempt to resolve the problem. Specify the names of theresponsible Gatineau officials with whom you dealt on this matter.(additional space on the back)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2. Location of the complaint and file number, if known:______________________________________________________________________________________Solution soughtWhat would you consider a satisfactory solution?________________________________________________________________________________________________________________________________________________________________The information provided and the documents appended to this form will be handled confidentially, and will only beforwarded to the individuals authorized to address this request.I authorize the commissioners and staff of the Ombudsman’s Office to review all the documents and information about methat may be required to examine my complaint.Date:Signature:

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