Credential Holder Complaint Form

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This notice supplements the Ethical Misconduct Process and Privacy Policy as to the specific information collected and used in handling a Complaint as described below.

Information Collected: Information submitted through this form and otherwise collected in relation to the Complaint (“Complaint Information”), which can include:

Contact information of the Complainant and Credential Holder
Credentials of the Credential Holder
Description and Details Relating to the Complaint
Information collected from third parties such as Credential Holder’s employer

To obtain certain records, CSI may need to provide the Credential Holster’s employer with consent to receive this information. Please provide the following consent to facilitate the full investigation of your complaint:

I authorize CSI to collect information relating to this investigation from Credential Holder’s employer where Complainant’s consent may be required for the collection, such as Complainant’s personal information including financial records.

Purpose for Collection: Complaint Information is collected for the purpose of investigating complaints as described on the Ethical Misconduct Process page.

Use and Disclosure of Complaint Information: Complaint Information will be used to investigate a complaint against a Credential Holder as described on the Ethical Misconduct Process page. Any or all of the Complaint Information may be disclosed as follows:

Necessary Disclosures:

CSI will disclose the details of the Complaint to the Credential Holder as part of the investigation.
Where required by law, CSI will disclose specific information to any third parties which may include regulators or law enforcement.
CSI may disclose specific Complaint Information where, in CSI’s view, it is necessary to conduct the investigation.

Optional Disclosures: CSI may disclose to any party related to the investigation, including witnesses, CIRO, provincial regulators, employers and law enforcement agencies.

You can opt-out of these disclosures by checking this box. Please note that this may limit CSI’s ability to fully investigate your complaint.

Retention of Complaint Information: We take our responsibility to protect the privacy and confidentiality of our clients' information very seriously, and please be advised that we will retain Complaint Information for as long as required by law or regulation, and we will destroy records that are no longer required. This is to ensure that we are in compliance with all applicable laws and regulations, and to protect the privacy and confidentiality of our clients' information.

By submitting this Complaint, I acknowledge I have read and understand the above notice as to how CSI will collect, use and disclose information relating to this Complaint.