Fillable Lap-toolkit-Complaint-ENG - Rev4_LA Complaint Form

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Lap-toolkit-Complaint-ENG - Rev4_LA Complaint Form

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LanguageAccessServices
ComplaintForm
Superior Court of California, County of [insert your county here]
[local physical address]
Model Statewide Complaint Form and Instructions for Court Users - September 2017 1
Language Access Services Complaint Form
Instructions
The California courts want all Californians, including those who do not speak English well, to have access to
the courts. If you have a complaint about language access services at a local court, or if you would like to
provide feedback about language access services, fill out and turn in the complaint form.
Please keep the following in mind:
• If you need language access services for an
active court case, send us your complaint as
soon as possible.
• Fill in as much information as you can. You do
not have to give your name, but it is helpful to
know how to contact you so we can get more
information if needed.
• You can use the form to provide comments or
suggestions about language access services.
• Language access complaints may be submitted
orally or in other written formats. However, use
of the court’s local form is encouraged to ensure
tracking and that the court received full
information of the complaint.
• Filing a complaint will not negatively affect your
court cases or the services you get at the court.
• Your complaint will NOT become a part of your
case file or part of your case.
• If you are making this complaint on behalf
of someone else, fill out the information of the
person we should contact about the complaint.
• You can fill out the form and turn it in at your
local courthouse by hand, postal mail or e-mail
it at the addresses below. You can also fill it out
and turn it in online.
For complaints about services at your local court
related to staff, court interpreters, or local
translations, fill out and mail or e-mail your complaint
form to:
Superior Court of California,
County of [insert your county here]
Attn: Language Access Representative
Address Line 1
Address Line 2
E-mail: [insert local email]
The form is available for free both in hard copy at
the courthouse and online on the court’s website.
For complaints about the Judicial Council’s
services—Judicial Council meetings, forms, or
other translated material hosted on
www.courts.ca.gov — do not use this form. Please
go to www.courts.ca.gov/languageaccess.htm to
submit your complaint.
Thank you for taking the time to let us know
how we are doing, and for helping us to
improve our language access services for all
Californians.
[insert your county here]
[local physical address]
[insert local url]
[insert local phone number]
[insert local email]
[insert your county here]
[Address Line 2]
[insert local email]
[insert name] Superior Court
Model Statewide Complaint Form and Instructions for Court Users - September 2017 2
Language Access Services Complaint Form
Language Access Services
Complaint Form
Fill out this form to complain about language
access services in the California courts. Provide as
much detail as possible. You do not have to give
your name or contact information if you do not want
to, but it will help us investigate your complaint.
Your complaint will NOT become a part of your case
file. Do not use this form if you have a complaint
about the outcome of your case.
If you want to provide other comments and
suggestions (not a complaint), fill out Part 2 of this
form, under “Give Us Feedback.”
Information about Person with Complaint:
Today’s date:
Name:
Telephone:
Address:
E-mail:
Primary language you speak:
Primary language you write:
Best contact method: ☐ mail ☐ e-mail ☐ phone
If you are filling out this form for another person,
please provide your contact information below:
Today’s date:
Name:
Organization:
Telephone:
Address:
E-mail:
Primary language you speak:
Primary language you write:
Best contact method: ☐ mail ☐ e-mail ☐ phone
PART 1. Describe the Complaint
Check and fill out all that apply.
☐ I asked for an interpreter but did not get one.
Tell us when (date) and where (location) this happened:
Case number (if any):
☐ I am not satisfied with the services of the interpreter.
Name of the interpreter:
Interpreter badge #: Date of interpreter service:
Location: Case number (if any):
Why were you not satisfied with the interpreter services?
[insert name] Superior Court
Model Statewide Complaint Form and Instructions for Court Users - September 2017 3
Language Access Services Complaint Form
☐ Other problem with court staff related to language access.
Date of incident:
Name of staff person:
Department:
Describe incident:
☐ The form I need is not in my language.
Give form number, name, or description:
☐ The information I need is not in my language.
Specify what information you need translated:
☐ The translation of the form or information I received has mistakes.
Describe document or information:
Describe mistakes:
☐ Other complaint related to language access.
Have you complained to another agency about this problem? ☐ Yes ☐ No
If Yes, provide the name of the agency:
Add any other information that may help us review your complaint:
[insert name] Superior Court
Model Statewide Complaint Form and Instructions for Court Users - September 2017 4
Language Access Services Complaint Form
PART 2. Give Us Feedback
☐ Other comments or suggestions:
Thank you. We will contact you within 60 days of receiving this form.
You can fill out the form and turn it in at your local courthouse by hand, postal mail or e-mail it at the
addresses below.
Superior Court of California, County of
[insert your county here]
[local physical address]
[insert local url]
[insert local phone number]
[insert local email]
[insert name] Superior Court
Model Statewide Complaint Form and Instructions for Court Users - September 2017 5
Language Access Services Complaint Form
Note: The following language could be provided by the court to the individual submitting the complaint
via e-mail or as an automatic online response if submitting it online.
Your complaint or comments have been submitted.
We will contact you within 60 days of receiving your complaint or comments.
We may need to contact you using the contact information you provided.
If your complaint, comments, or suggestions are about an issue not related to language access services,
we will send it to the appropriate court, agency, or department.
[insert name] Superior Court
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Lap-toolkit-Complaint-ENG - Rev4_LA Complaint Form

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Completed 21 May 2020

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