Fillable LANGUAGE ACCESS CUSTOMER COMPLAINT FORM Complete this form (Superior Court of California - County of San Francisco)

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LANGUAGE ACCESS CUSTOMER COMPLAINT FORM Complete this form (Superior Court of California - County of San Francisco)

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Updated: January 2019
Superior Court of California,
County of San Francisco
Court Interpreter’s Unit
850 Bryant Street, Room 101
San Francisco, CA 94103
LANGUAGE ACCESS CUSTOMER COMPLAINT FORM
Complete this form if you believe you have not been provided reasonable or professional language access. You are NOT required
to give your name or contact information, but it will aid our investigation of your complaint. This form is to be submitted either to
the physical address above or to language-access@sftc.org. This form will NOT become a part of your case file.
NAME:_____________________________________________________________ TODAY’S DATE:________________________
ADDRESS:_____________________________________________________ TELEPHONE NUMBER: (____)________________
EMAIL ADDRESS:_________________________________________ Best method of contact:
CASE NUMBER (if any): __________________________________________________
WHERE DID THE INCIDENT HAPPEN? (check one):
Civic Center Courthouse Community Justice Center Juvenile Justice Center Hall of Justice
WHEN DID THE INDICDENT HAPPEN? (please provide the exact date or time frame such as “last week”)
___________________________________________________________________________________________________________
WHAT IS YOUR COMPLAINT ABOUT? (check all that apply):
Interpreter: (Name):________________________________ Language:______________________________________
Courthouse Staff (Name):_________________________________ Department:_______________________________
Language Access:
Other, specify:____________________________________________________________________________
PLEASE DESCRIBE YOUR COMPLAINT. You may attach additional sheets if necessary.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Additional sheets attached.
WHAT WOULD YOU LIKE HAVE DONE AS A RESULT OF THIS COMPLAINT?
__________________________________________________________________________________________
__________________________________________________________________________________________
____________________________________________________________________________________________________________
WHAT OTHER INFORMATION DO YOU THINK IS IMPORTANT FOR US TO KNOW?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
********************DO NOT WRITE BELOW THIS LINE********************
Date Received:
Date Reviewed:
Date of Action Taken:
b
By (initials):
By (initials):
By (initials):
mail
e-mail
I asked for an interpreter but did not receive one.
The information or forms I need are not in my language.
The translation of the information or forms I received contained mistakes.
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LANGUAGE ACCESS CUSTOMER COMPLAINT FORM Complete this form (Superior Court of California - County of San Francisco)

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Completed 4 January 2021

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