Appendix A.7: Sample Complaint Information Sheet

Questions and Concerns Call Log Sheet
Name:
Person/Dept Calling:
Date/Time:
*Call #:
Question or Concern:
Action Taken:
Follow-Up Date:
Follow-Up Action:

* How to make call # assignment: The month plus initials of the person taking the call plus the # of call. Log knowledge-based concerns or questions, i.e., billing, policies, education, financial statements, contracts, et cetera (for example: 08 DT 001).

About SCCE

The Society of Corporate Compliance and Ethics (SCCE) is a non-profit, member-based professional association. SCCE supports our members' work with education, news, and discussion forums. We are a community of leaders, defining and shaping the corporate compliance environment across a wide range of industries and geographic regions. In developing and maintaining effective ethics and compliance programs, our members strengthen and protect their companies.

952.933.4977

About HCCA

The Health Care Compliance Association (HCCA), is a 501(c)6 non-profit, member-based professional association. HCCA was established in 1996 and is headquartered in Minneapolis, MN. We provide training, certification, and other resources to over 10,000 members. Our members include compliance officers and staff from a wide range of organizations, including hospitals, research facilities, clinics and technology service providers.

952.988.0141

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