Request for Facilitation and Discussion

Ombudsman Service Procedure
Step 1: Resolution through Facilitation

PLEASE COMPLETE THE FORM BELOW:

All fields are mandatory unless otherwise indicated.

As the Complaint, where are you located:(Required)

Please enter the name of the Crown Dependency(Required)

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Please enter the name of the UK Overseas Territory(Required)

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Please enter the name of the country(Required)

Please enter the name of the country outside the UK, Crown Dependencies, and UK Overseas Territories.

Where is the Respondent located:(Required)

Please enter the name of the Crown Dependency(Required)

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Please enter the name of the UK Overseas Territory(Required)

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Please enter the name of the country(Required)

Please enter the name of the country outside the UK, Crown Dependencies, and UK Overseas Territories.

Under which countries legislation is the Contract, Agreements, Terms of Reference, or Terms and Conditions signed?(Required)

Please enter the name of the Crown Dependency(Required)

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Please enter the name of the UK Overseas Territory(Required)

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Please enter the name of the country(Required)

Please enter the name of the country outside the UK, Crown Dependencies, and UK Overseas Territories.

COMPLAINANT:

Name(Required)

Prefix First Middle Last Suffix

Email(Required)

Your email address will only be used to contact you in relation to your Request for Facilitation. If your email address changes, please email ombudsman-service@ircmcic.org with updated details, with your name in the Subject line.

Enter Email Confirm Email

Telephone(Required)

If it is required, your telephone number will only be used to contact you in relation to your Request for Facilitation.
If your telephone number is not provided, the Ombudsman Service will rely on email to progress this Request for Facilitation.

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Are you the Complainant or someone acting on behalf of the Complainant?(Required)

Acting on behalf of the Complainant - Complainants name:(Required)

It is important that the Complainants name appears in all the Ombudsman Service documentation.

Acting on behalf of the Complainant - Complainants email:(Required)

The Complainant's email address will only be used to copy all communication between yourself and the Ombudsman Service. If the Complainant's email address changes, please email ombudsman-service@ircmcic.org with updated details, with your name and the Complainant's name in the Subject line/

Enter Email Confirm Email

Acting on behalf of the Complainant - Complainant's address:(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Acting on behalf of the Complainant - your role/responsibility and reason:(Required)

Please confirm your relationship with the Complainant. i.e. are you a friend, colleague, solicitor, accountant, etc.; and on the second and following lines, explain the reason you are requesting the Facilitation or Discussion on behalf of the Complainant.

Acting on behalf of the Complainant - reason:(Required)

Please explain the reason you are requesting the Facilitation and not the Complainant.

Both your name and the Complainant’s name will be included on all reports:(Required)

Do you give permission for your name and relationship with the Complainant to be included on all reports as the Complainant’s representative?

What is the reason you do not want your name to be included on all reports?(Required)

If you have a relationship with the Respondent, please include these details.

COMPLAINANTS RELATIONSHIP WITH THE RESPONDENT:

What is the Complainants relationship with the Respondent?(Required)

If the Complainant has more than one relationship with the Respondent i.e. student and client; please select other and enter the details in the following field.

Complainants Relationship with the Respondent - Other(Required)

RESPONDENT’s NAME and CONTACT DETAILS:

Is there one or more than one Respondent involved in this grievance?:(Required)

Respondent:(Required)

This is the main Respondent and not a Third Party or Witness.
If there is no formal organisation name, please enter 'NONE'.

First name

Surname/Last name

Organisation name

Email address

Phone number

Additional Respondents:(Required)

Please enter the second and any additional Respondents. These are not Third Parties or Witnesses.
If there is no formal organisation name, please enter 'NONE'.
Please use the + sign to add additional Respondents.

First name

Surname/Last name

Organisation name

Email address

Phone number

THIRD PARTY(IES) and/or WITNESS(ES):

Is there one or more Third Parties involved?(Required)

Third Party:(Required)

This is the Third Party and not a Respondent or Witness.
If there is no formal organisation name, please enter 'NONE'.

First name

Surname/Last name

Organisation name

Relationship to the Respondent

Email address

Phone number

Additional Third Parties:(Required)

Please enter the second and any additional Third Parties and not Respondents or Witnesses.
Please use the + sign to add additional Third Parties.
If there is no formal organisation name, please enter 'NONE'.

First name

Surname/Last name

Organisation name

Relationship to the Respondent

Email address

Phone number

Is there one or more Witnesses involved?(Required)

Witness:(Required)

This is the Witness and not a Respondent or Third Party.
If there is no formal organisation name, please enter 'NONE'.

First name

Surname/Last name

Organisation name

Relationship to the Respondent

Email address

Phone number

Additional Witnesses:(Required)

Please enter the second and any additional Witnesses and not Respondents or Third Parties.
Please use the + sign to add additional Third Parties.
If there is no formal organisation name, please enter 'NONE'.

First name

Surname/Last name

Organisation name

Relationship to the Respondent

Email address

Phone number

Outline communication:(Required)

Please provide the outline of all communications between the Complainant, and/or the Third Party/Parties and/or the Witnesses.

REASON FOR YOUR REQUEST FOR FACILITATION:

Please enter the relevant clause or clauses reference separating each reference on a different line.
Please enter ‘NONE’ where there is no applicable code.

Coaching and Mentoring Industry Standards and Ethics(Required)

click here and select 'Standards Ethics' to access the Coaching and Mentoring Industry Standards and Ethics.
Please enter the section heading, the clause reference, and your reason for selecting that heading/clause. Please click the + sign to enter each reason.

Section heading

Clause reference

Reason

Coaching and Mentoring Industry Core Competencies(Required)

click here and select 'Core Competencies' to access the Coaching and Mentoring Industry Core Competencies.
Please enter the section heading, the clause reference, and your reason for selecting that heading/clause. Please click the + sign to enter each reason.

Section heading

Clause reference

Reason

REQUEST FOR FACILITATION DETAILS:

Please enter the details in the fields below, explaining the details of this Request for Facilitation.
In the fields below:
- explain the event, the actions, all communication, and relevant information.
- at this point in the process, the Ombudsman Service is looking for the specifics in relation to how this Request for Facilitation came about.
The Ombudsman Service may request additional information, to support the details you provide here and in the following fields.

Summary:(Required)

Please provide a summary of how this Request for Facilitation came about.

1. Background:(Required)

Please provide the background to the relationship between the Complainant and the Respondent.

2. Events:(Required)

Please provide the details of each event that led to you raising this Request for Facilitation.

3.1 Actions of Complainant:(Required)

Please provide the details of each action you took before raising this Request for Facilitation.

3.2 Actions of Respondent:(Required)

Please provide the details of each action that the Respondent took that led to you raising this Request for Facilitation .
Where there is more than one Respondent, it is important that you start each action with the Respondent's name.

3.3 Actions of Third Party/Parties:(Required)

Please provide the details of each action that the Third Party/Parties took that led to you raising this Request for Facilitation.
Where there is more than one Third Party/Parties, it is important that you start each action with the Third Party/Parties name.

3.4 Actions of Witness/es:(Required)

Please provide the details of each action that the Witness/es took that led to you raising this Request for Facilitation.
Where there is more than one Witness/es, it is important that you start each action with the Witness/es name.

4. What was the point at which you decided that you needed to contact the Ombudsman Service?:(Required)

5. Any further relevant information?(Required)

Please enter ‘NONE’ if there is no further relevant information.

ADDITIONAL INFORMATION:

Has this grievance been raised through the Respondents Complaints Policy and Procedure?(Required)

1. Respondent’s Complaints Policy and Procedure Contact:(Required)

Respondents Complaints Policy and Procedure link:

Respondents Contact Name:

Respondents Contacts email address:

2. Status(Required)

Please provide the current status of your proceedings.
If your proceeding is still active, you may register your Request for Facilitation with the Ombudsman Service, but no action will be taken until these proceedings have completed.

3. Outcome(Required)

Please provide the outcome of your proceedings.
If your proceeding is still active, please enter ‘still active’ in this field. You may register your Request for Facilitation with the Ombudsman Service, but no action will be taken until these proceedings have completed.

4. Reason(Required)

Please provide the reason your proceedings did not provide you with a successful outcome.
If your proceeding is still active, please enter ‘still active’ in this field. You may register your Request for Facilitation with the Ombudsman Service, but no action will be taken until these proceedings have been completed.

What is the reason you have not raised this grievance with the Respondent?(Required)

Has this grievance been raised with another organisation?(Required)

1. Was this grievance raised as a:(Required)

2. Organisation details(Required)

If you have raised this grievance with more than one organisation, please click the + sign to enter the additional organisations details.

Type of Organisation

Name of Organisation

Name of Contact at the Organisation

Contact details: email address

Contact details: telephone

3. Status(Required)

Please provide the current status of your proceedings.
If you have raised this grievance with more than one organisation, please use the + sign to put each status update on a new line with the Organisation Name first.
If your proceeding is still active, you may register your Request for Facilitation with the Ombudsman Service, but no action will be taken until these proceedings have been completed.

Name of Organisation

Status

4. Outcome(Required)
Please provide the outcome of your proceedings.
If you have raised this grievance with more than one organisation, please use the + sign to put each outcome on a new line with the Organisation Name first.
If your proceeding is still active, please enter ‘still active’ in this field. You may register your Request for Facilitation with the Ombudsman Service, but no action will be taken until these proceedings have been completed.
Name of Organisation
Outcome

5. Reason(Required)
Please provide the reason your proceedings did not provide you with a successful outcome.
If you have raised this grievance with more than one organisation, please use the + sign to put each reason on a new line with the Organisation Name first.
If your proceeding is still active, please enter ‘still active’ in this field. You may register your Request for Facilitation with the Ombudsman Service, but no action will be taken until these proceedings have been completed.
Name of Organisation
Reason

If you have documentation to support your Request for Facilitation, please upload the documentation (optional).
If you wish to forward your supporting information by email, please email ombudsman-service@ircmcic.org and include your name (as entered above) in the subject line.

Drop files here or

Accepted file types: jpg, jpeg, png, doc, pdf, png, gif, Max. file size: 350 MB, Max. files: 10.

PREFERRED OUTCOME:

What are you expecting as a resolution to your Request for Facilitation?(Required)

ADDITIONAL INFORMATION

Please enter any Additional Information relevant to your Request for Facilitation and Discussion.

How did you hear about the Ombudsman Service?(Required)

Please explain how you heard about the Coaching and Mentoring Ombudsman Service:(Required)
Please use this field to explain how you heard about the Ombudsman Service. Thank you.

Ombudsman Service Policy and Procedures(Required)
By submitting this form, I confirm that I have read the full Ombudsman Service Policy and Procedures and give authority for the information submitted on this form to be (1) shared with the other party or parties detailed, (2) shared with other relevant parties unless I have stated that I do not want specific elements of information to be shared.

Ombudsman Service Policies and Procedures(Required)
By submitting this form I acknowledge that all policies and procedures will be followed and documented.

Information(Required)
By submitting this form, I confirm that all information submitted to the Ombudsman Service on this form and through all other requests for information by the Ombudsman Service, the information (1) may be utilised to progress and bring this Request for Facilitation to a conclusion, (2) may be stored in the Ombudsman Service Register, (3) may be retained for as long as all parties remain within the Coaching and Mentoring Industry, or for longer if necessary.

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Currently, all information provided by and correspondence with the IRCM CIC is in English.

Ombudsman Service Procedure Step 1: Resolution through Facilitation

COMPLAINANT:

COMPLAINANTS RELATIONSHIP WITH THE RESPONDENT:

RESPONDENT’s NAME and CONTACT DETAILS:

THIRD PARTY(IES) and/or WITNESS(ES):

REASON FOR YOUR REQUEST FOR FACILITATION:

REQUEST FOR FACILITATION DETAILS:

ADDITIONAL INFORMATION:

PREFERRED OUTCOME:

ADDITIONAL INFORMATION

Ombudsman Service Procedure
Step 1: Resolution through Facilitation