This form can be download here » Customer Complaint Form
Fields marked * are mandatory for a successful investigation
BHC Complaint Ref:
Internal Use Only
*Name of Reporter:
*Date form completed:
*Contact method: Email:Telephone:
Customer complaint reference (if applicable):
*Name of above:
Bunzl HealthcareEmployeeDistributor CustomerEnd UserMHRA
If end user, please provide Job Title:
*Product Description (include pack size):
*Lot / Batch:
Number of identical events with the same Lot/Batch Number: Unknown OR If known please specify number:
*Is the sample available?
NoYes, not contaminatedYes, contaminatedPhoto evidence only
Customer PO Number:
Date Returned: Internal use only
** WE REQUIRE A COMPLETED DECONTAMINATION CERTIFICATE BEFORE AUTHORISING THE RETURN OF USED SAMPLES **
Procedure / Date:
Completed with this device/packCompleted with another device/packCompleted with a different device/packAborted due to this eventAborted due to same device/pack unavailableNo information availableAborted due to another reason
Time of event:
*If Yes, please provide details of methods of medical intervention required:
If the answers to 1 and 2 are yes and no, this complaint will be treated with priority and the TQRM will be consulted to decide if the competent authority needs to be notified.
Assessment carried out by:
Non Reportable Incident NoYes
Reportable Incident NoYes
Competent Authority Reference
Upon submission a copy of this form will be sent back to you, please ensure your email is correct.
If you do not receive an email within 24 Hrs please call the Complaints Department on (+44) 01905 778365.
Prices shown are excluding Tax (VAT).
For International Orders Please Call: +44 1905 778365 Dismiss