Representations about a Notice served by the
Care Quality Commission
Please fill in all parts of this form.
Applicant:
Reference number on
Notice (important):
Regulated activity:
Date of Notice:
If you are sending representations by post or fax, please send to:
Care Quality Commission
Citygate
Gallowgate
Newcastle upon Tyne
NE1 4PA
Fax: 03000 616172
If you are sending by email, please send to:
[email protected]
Please note:
This form should only be used where you are challenging the notice served and
wish to explain why you think CQC should withdraw the notice.
You must submit your full representations within 28 calendar days of service of a notice
proposal, and within 10 days of service of a warning notice.
20160226 200034 Representations form all purpose
I/we wish to make the following representations:
Please continue on additional numbered sheets (box will expand if used on a computer)
Tick here if you have made comments about the factual accuracy of the inspection
report, and wish us to consider those comments when making a decision about
publication.
Completed by (name(s))
Position(s)
Date
20160226 200034 Representations form all purpose
Continued …
20160226 200034 Representations form all purpose