Submit a Professional Conduct Review Filing a Complaint(Required) Please note that ALL TIMELINES are being suspended for PCR investigations. I agree to have familiarized myself with both the CACCF PCR Policy and the Canon of Ethics documents in full. I agree to file a complaint using this form, in writing, that will be addressed to the Executive Director.Name and Workplace of CACCF Certified member this complaint is about:(Required) Please specify the exact nature of the complaint and provide all details and substantiating evidence regarding the complaint.(Required)Describing the event and subsequent actions (did you tell someone else/not come back to work/etc.) is sufficient evidence.Please provide substantial information and facts about the complaint. Attach any files related.(Required) Drop files here or Select files Max. file size: 32 MB, Max. files: 5. Please select below at least one or more of the components of the CACCF Canon of Ethics that were breached:(Required) Believe in the dignity and worth of all human beings, striving to recognize all people from all races and spiritual beliefs, sexual genders and orientations. Pledge my service to the well-being and betterment of all members of society without discrimination. Recognize the right to culturally sensitive and evidence -based treatment for anyone experiencing a substance use disorder or behavioural addiction. Promote and assist in the recovery and return to wellness of every person served. Uphold each person’s right to self-determination and referring them professionally to other programs or individuals when in their best interest. Maintain proper professional relationships to all persons served ensuring that all interpersonal transactions between myself and persons served, are non-exploitive and essential to their well-being and recovery, while recognizing our fiduciary responsibility Adhere strictly to establish principles of confidentiality in all knowledge, records, and materials concerning persons served directly and indirectly, and in accordance with any institutional and any current government regulations. Ensure that all interpersonal transactions are non-exploitive. Give due respect to the rights, views, and positions of any other addiction counselors and related professionals. Respect institutional policies and procedures, and cooperate with agency management with which I may be associated, as long as this remains consistent with recognized standards, procedures and ethics. Contribute my ideas and findings regarding substance use disorders and behavioral addictions and their treatment and recovery. Maintain an individual responsibility for personal conduct in all lifestyle areas, so as not to diminish my professional competence, integrity, legal obligation. I further agree that I will refrain from any breach of the Criminal Code of Canada. Avoid claiming or implying any personal capabilities for professional qualifications beyond those I have attained, recognizing competency gained in one field of activity must not be used improperly to imply competency in another. Regularly evaluate my own strengths, bias, or levels of effectiveness, always striving for selfimprovement and seeking professional development by means of further education, training, and clinical supervision. Social media (Facebook, Twitter, etc.) should be used in a professional manner only What efforts have been undertaken, if any, by you, the complainant, to resolve the situation prior to filing the complaint?(Required)Complainant Name:(Required) First Last Complainant Address:(Required) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Complainant Email:(Required) Complainant Phone Number:(Required)
