TROY COMPLAINTS REPORTING FORM | TLSF174
Attention: Quality Manager, Troy Laboratories Pty Ltd | Refer to QMS-GEN-013 – Complaints
Product Name: *
Date Complaint Received:
Batch No:
Expiry Date:
Customer Name:
Complaint reply requested: YesNo
Contact Number: *
Email: *
Mailing address:
Date complaint detected:
Explain where the product was stored and at what temperature:
Date Product was Broached:
Complaint Sample Available YesNo
If No, Explain:
Replacement Product Required? YesNo
Replacement Product Received / supplied? YesNo
Explain the Nature of the Complaint (Tick all applicable): Adverse EventEfficacy IssueSafety IssuePackaging issueProduct LeakageEmpty ContainersDiscolouration of the ProductDelivery IssueOther
If you selected Other above please explain:
Please explain the complaint in detail below.
Complaint sample(s) expected: YesNo
Photo(s) expected: YesNoUploaded
Upload Photos if available:
Extra information attached YesNo
Upload Extra Information:
Species & Breed:
Age:
Weight:
Other animals affected?: YesNo
Number:
Details:
Dosage:
Route of Administration:
Product Used as per the label: YesNo
Concomitant product use: YesNo
Name:
Dose:
Manufacturer:
Batch Number and Expiry Date
Vet Name:
Practice Name:
Completed By:
Date:
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