Child Welfare Worker Complaint Form
Use this form to submit a complaint about a child welfare worker. Please provide as much detail as possible to help us address your concerns.
Your Name (optional)
Preferred Follow-Up Contact Method
*
Email
Phone
No follow-up needed
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name of the Worker Involved
*
Worker's Department or Role (if known)
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Incident
Description of the Incident
*
Additional Comments (optional)
Submit Complaint
Should be Empty: