Complaint Form
The Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information, LRQ, c. A-2.1
and
The Act Respecting the Protection of Personal Information in the Private Sector, LRQ,
c. P-39.1
The Commission d’accès à l’information (“Commission”) is responsible for ensuring the application of the Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information (“Access to Information Act”) and of the Act Respecting the Protection of Personal Information in the Private Sector (“Private Sector Act”).
The Commission may, of its own initiative or following a complaint, open an investigation to determine if a public agency or business, through its practices or behavior, is in compliance with the rights and obligations stipulated in the Access to Information Act or the Private Sector Act.
Following its investigation, the Commission may recommend or order the application of any corrective measure in order for the public agency or business to comply with the requirements of the Access to Information Act or the Private Sector Act, and to ensure the protection of personal information.
It is important to note that the Commission does not have the power to grant damages.
Complaints must be submitted in writing to the Commission, by the person concerned (or his representative) who considers that the Access to Information Act or the Private Sector Act has not been respected with regard to the collection, retention, use, disclosure or destruction of personal information.
NB: The Complaint Form should not be used to gain access to or request a correction of your personal information, nor to request the review of a decision regarding a request for access or a correction made to a public body or business. Specific forms are available on the Commission’s website.
When and how to make a complaint :
The concerned person (“plaintiff”) who considers that the Act Respecting the Protection of Personal Information in the Pubic Sector has not been respected can submit a complaint to the Commission.
Before making a complaint, the commission encourages the plaintiff to attempt to resolve the situation directly with the public body or business, either in writing or verbally, whenever possible.
Upon receipt of a complaint, the Commission will first assess its admissibility, and then determine the best way to resolve the issue.
In order for the Commission to assess the admissibility of a complaint and the complaint form, you must provide the following documents:
· The consent form
You must authorize the Commission staff to communicate your identity, your complaint and any relevant documents provided to support your complaint to the public body or business concerned.
You must sign the attached consent form; otherwise the Commission will not be able to process your complaint.
· Relevant items
All supporting documents (letters, written testimonies, forms, etc.) must be submitted along with your complaint form.
You may submit copies and keep the originals for your records.
The person concerned may submit a complaint to the Commission by completing the complaint form and attaching all supporting documents. Contact information for the Commission is available at http://www.cai.gouv.qc.ca under the “Nous joindre” section.
COMPLAINT FORM
The Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information, LRQ, c. A-2.1
and
The Act Respecting the Protection of Personal Information in the Private Sector, LRQ,
c. P-39.1
SECTION 1: Information on the plaintiff/representative
1.1. Information on the plaintiff
Last name: / First name:Mailing address:
City: / Postal code:
E-mail address: / Telephone number (daytime):
1.2. Information on the Representative (if applicable)
Last name: / First name:Mailing address:
City: / Postal code:
E-mail address: / Telephone number (daytime):
(Information contained on this form is protected by the Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information (L.R.Q., c. A-2.1).)
SECTION 2: Information on the public body or business concerned*
Name and title of individuals involved:
-
-
-
Complete mailing address:
City: / Postal code:
E-mail address: / Telephone number:
Fax number:
*Indicate the head office or place of business in Quebec
SECTION 3: Facts supporting the complaint
1. What is your relationship with the public body or business named in your complaint? (e.g., customer, employee, tenant)
2. Please specify the personal information that relates to you directly, which is subject to your complaint. (e.g.: Identification number, medical or financial information, driver’s license, personnel file, etc.)
3. Describe your complaint. Be sure to include the facts, and when and how the events took place. If more space is required, attach additional pages to the form.
4. Did you attempt to resolve the issue directly with the public body or business concerned? If so, what steps did you take and what was the end result? If applicable, attach a copy of any correspondence with the public body or business.
SECTION 4: Outcome
1. Describe the corrective measures necessary to resolve the situation. An answer to this question is optional, and is only intended to understand your expectations so that we can provide you with the most complete information possible.
SECTION 5: Required signatures and documents
Please attach copies of the following documents:
¨ Any relevant documents to support your complaint
¨ Any communications regarding the complaint between you and the public body or business
¨ The duly signed and dated consent form
I certify that the information on this form is to the best of my knowledge true and complete.
First and last name (in block letters)
Signature Date
Consent Form
In order to process my complaint, I authorize the Commission d'accès à l'information du Québec to transmit a copy of my complaint along with any supporting documents submitted to the Commission to the individuals involved and in particular [enter the name(s) of the public body or business]
This authorization remains valid for the duration of the complaint.
First and last name (in block letters)
Signature Date
Revised May 2013 Page 4 of 7