This form is to be used should you believe that there has been a breach by a licensee or former licensee under the Construction Occupations (Licensing) Act 2004 (COLA), or an operational Act; and/or a person is conducting or has conducted a controlled activity under the Planning and Development Act 2007 (PDA). Fields marked with an (*) must be completed.

Before completing this form please read the fact sheet on Development and Construction Occupation Complaints which provides information about breaches of COLA and Controlled Activities. All reasonable steps will be taken to investigate your complaint.

Please note:

•	You may be required to provide further information as part of the investigation process.
•	Complaints are prioritised based on the risk to public safety.
•	Investigation and action on your complaint may take a significant amount of time to be completed.  You will be kept informed of the progress of the investigation.

The completed form can be submitted by email to actplalru@act.gov.au or posted to the EPD Investigation Unit, PO Box 158 Canberra City ACT 2601.

Lease/Site Details – Subject of the Complaint

Block	
	Section 		Suburb		Unit No.		

Street Address	

Applicant Details Please Print

Surname	
		First Name		
		
Postal Address	

Phone Number Business Hours			Mobile		
		
EMAIL ADDRESS	

Summary of Complaint - please tick

UNLAWFUL DEVELOPMENT		BREACH OF LEASE	
•	Development without approval		•	Unclean leasehold	
•	Development Not in accordance with an approval		•	Unlawful Use	
			
CONSTRUCTION WORK		LICENSEE	
•	Building		•	Unlicensed	
•	Electrical		•	Licence Breach	
•	Plumbing		•	Building Certifier	
•	Gas		•	Works Assessor	
Details of Complaint

Please provide a full description of your complaint and attach any technical reports or associated material

	

	

	

	

	

	

Applicant Acknowledgment

I/we the undersigned acknowledge:

•	we have read and understood the details outlined on this form.
•	that this complaint, including the personal information provided on this form, may be referred to another 
ACT Government agency or ACT Policing for the purposes of investigating the complaint or a breach of another law;
•	that all the information given on this form and its attachments is true and correct.

Applicant Name(s)	

Applicant Signature (s)	
	Date		

Privacy Notice
The personal information on this form is provided to the Environment and Planning Directorate (EPD) to enable the processing of your application. The collection of personal information is authorised by the Planning and Development Act 2007 and the Construction Occupations (Licensing) Act 2004.  If all or some of the personal information is not collected EPD cannot process your application. The personal information you provide may be disclosed where the Directorate reasonably believes that the use or disclosure of the information is reasonably necessary for enforcement-related activities conducted by, or on behalf of, an enforcement body. EPD’s Information Privacy Policy contains information about how you may access or seek to correct your personal information held by EPD, and how you may complain about an alleged breach of the Territory Privacy Principles. The EPD Information Privacy Policy can be found at www.environment@act.gov.au 

Contact Details:
Environment and Planning Directorate
Customer Service Centres
GPO Box 158, Canberra City 2601
8 Darling Street Mitchell, ACT 2911
16 Challis Street Dickson ACT 2602
Business Hours: 8.30am to 4.30pm weekdays (excluding Public Holidays)
Phone: (02) 6207 1923	TTY: (02) 6207 2622
Email: epdcustomerservices@act.gov.au	Website: www.environment@act.gov.au