Online Safety Commission Complaint Form 1. First Name * 2. Last Name * 3. Address * 4. Gender * -None- Male Female Other 5. Age * 6. Phone * 7. Email * 8. Employment Status -None- Employed Unemployed Student 9. Occupation 10. School (if student) 11. Other details 12. Relationship to complainant 13. Alleged date of incident 14. Platform/medium used 15.Details of incident and subject electronic comm 16. Alleged person complaint against 17. Contact details of person stated in 16 above 18. Further details of person stated in 16 above 19. Relationship to person stated in 16 above 20. Other parties
