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County Roscommon Disability Support Group

Set up in 1989 for people with disabilities, by people with disabilities, based on the Social Model of Disability & the Principles of Independent Living

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Complaints Form

Name *

First

Last

Email *

Email

Confirm Email

Home Address *

Eircode

Mobile Phone No. *

Home Phone No.

Relationship to Service User *

Name of Service User (if different)

First

Last

Address of Service User (if different)

Eircode of Service User (if different)

Mobile Phone No. of Service User (if different)

Home Phone No. of Service User (if different)

Date of Complaint *

DD/MM/YYYY

Date of Incident *

DD/MM/YYYY

Location of Incident *

Complaint Details *

What would be a satisfactory outcome to this complaint? *

Witness/es (if applicable):

Witness/es Mobile No.

Witness/es Contact Details:

Witness/es Eircode:

I authorise RSG to contact witness/es

Yes, I authorise
No, I do not authorise

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

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Latest News

Work Experience 5N1356 | 19th June 2023
Communications 5N0690 | 15th May 2023
Safety & Health At Work 5N1794 | 17th April 2023
Infection, Prevention & Control 5N3734 | 6th March 2023
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RSG Centre, Derrane, Co. Roscommon F42 WK60 | Phone: +353 (0)90 66 25852 | Email: info[at]rsg.ie
A Not for Profit Organisation. Established 1989. Charity No.: 20029166 | Company No.: 231700
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