Dépôt de plaintes

Formulaire de plainte relative à la protection des renseignements personnels ou à la désindexation

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Plaignant.e

Information sur le ou la plaignant.e(Required)

Nom Prénom

Coordonnées

No. civique et rue Adresse (suite) Ville Province Code postal

Comment pouvons-nous vous rejoindre?

Canal préféré de prise de contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You(Required)

Representative

If you have an appointed legal representative, please provide their contact information.

Representative Name(Required)

First Last

Representative Address

Street Address Address Line 2 City Province Postal Code

Representative Phone

Representative Email

Targeted Enterprise

Information about the targeted enterprise

Company name(Required)

Name(s) and title(s) of the person(s) involved

Description of the complaint

Dates (periods) and location(s) of the event(s)

What is your relationship with the company you are filing the complaint about?

(I.e. State whether you are a customer, member, board member, employee, tenant, etc.)

Does your complaint have to do with a situation you have experienced personally? Or, do you wish to report a general situation you feel is problematic for the protection of personal information or access to information? Please specify.

If applicable, what personal information is the object of your complaint?

(I.e. Note whether it concerns medical records, driver’s license, social or health insurance number, photographic or video surveillance images, fingerprints, etc.)

Facts that support the complaint

Please describe the facts supporting your complaint.

Describe the events or circumstances related to your complaint:

Dates and locations of the events:

Actors or witnesses:

Have you already contacted our company with your complaint? If so, what steps have you taken and what was the outcome?

Please send us a copy of any correspondence with the company, if applicable.

Have you filed a complaint with another government agency or police force concerning the same event(s)?

If so, please provide details (name of the organization, file number, outcome, etc.).

Desired outcome: In your opinion, what corrective measures would resolve the problem?

Stop collecting unnecessary personal information

Destroy my personal information

De-indexation

Modifying your practise

Other:

Signatures and required documents

Please attach copies of the following: Any relevant documentation in support of your complaint (forms, files, photographs, etc.) All correspondence about the complaint, between you and the company or public body concerned

Your Comments/Questions

Important note:

The information collected in this form will be used to assess the admissibility of your complaint by a team who will conduct a preliminary analysis and determine the best course of action, if any, for the company. The information may also be used for an investigation, inspection, or any other intervention the company deems useful. You may access this information at any time. You have the right to ask for corrections if it is inaccurate, incomplete, or unclear. If you have questions about how the Coopérative de développement régional du Québec protects your personal information, please contact the Privacy Officer charged with the Commission d’accès à l’information reporting at info@cdrq.coop. You will find all the information you need on our website: www.cdrq.coop