Building Services Page 1 of 2
519-837-5615, (revised April 2020)
Code of conduct complaint
A. Complainant and other persons information
Last Name: First Name:
Mailing address:
Municipality: Postal code:
Telephone number: Email:
Other persons present (if known):
Telephone number: E-mail:
Other persons present (if known)
Last name: First name:
Mailing address:
Municipality: Postal code:
Telephone number: Email:
B. Incident information
Date of incident: Time of incident:
Staff member name (if known):
Vehicle number (if known/applicable):
C. Details of the complaint
Please indicate the details of your complaint:
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Collection of Personal Information
Notice of Collection: Personal information on this form is collected under the
authority of the Municipal Act 2001, and the Municipal Freedom of Information and
Protection of Privacy Act (MFIPPA). The purpose of this collection is to examine your
complaint, which will be used as part of the City of Guelph’s investigation. All
personal information and the nature of your complaint will be handled in as
confidential a manner as possible. Any questions related to this collection should be
directed to the City of Guelph’s Access, Privacy and Records Specialist at 519-822-
1260 extension 2349.
Alternate formats of this document are available as per the Accessibility for
Ontarians with Disabilities Act by contacting Building Services at 519-837-5615 or
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