Customer Complaint Form template

A form in the Complaints and Feedback procedure (PR06), mapped to ISO 15189:2022 clause 7.7. Fill it in whenever the task occurs. Used by the quality-management team.

FormISO 15189 · 7.7As needed

Calculated automaticallyRed = outside limits

Your LaboratoryCustomer Complaint Form | YL-QM-FRM-06-F01 v1.0

Record: Customer Complaint Form — October 2026

Complaint No. (QO assigns)REF-26-001

Date Received2026-10-01

Complainant Name (optional)T. Moyo

Contact / Ward+27 11 555 0110

Type of ComplaintTAT/Delay

Received byS. Dlamini

Complaint DescriptionMonthly QC review

Is complaint substantiated?Yes

PriorityHigh

Root Cause Analysis

Corrective Action TakenNone required

NC No. (if opened)NC-26-001

Date Closed2026-10-01

Complainant Informed? (Y/N)Y

Date Notified2026-10-01

Complainant Satisfied? (Y/N)Y

Follow-up Date2026-10-01

Sign-off

Role	Name	Signature	Date
Completed by
Reviewed by

Shaded cells are calculated automatically. Values in red are outside their limits. † marks a corrected value (see Corrections).

Controlled document. Printed copies are uncontrolled unless stamped.Page 1

A4 portrait · first page · showing 0 of 0 rowsExactly as LabToolkit Pro prints it — with your logo and colours

What it records

Complaint No. (QO assigns)
Date Received
Complainant Name (optional)
Contact / Ward
Type of Complaint
Received by
Complaint Description
Is complaint substantiated?
Priority
Root Cause Analysis
Corrective Action Taken
NC No. (if opened)
Date Closed
Complainant Informed? (Y/N)
Date Notified
Complainant Satisfied? (Y/N)
Follow-up Date

Sign-off

Completed by
Reviewed by

Related templates

Use it as a live form in LabToolkit Pro Get it in the ISO 15189 template pack (US$149)

Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.