Employee Complaint Form - Level One Page 2

Please describe any efforts you have made to resolve your complaint informally and the

responses to your efforts.

With whom did you communicate?

On what date?

Please describe the outcome or remedy you seek for this complaint.

Employee signature

Signature of employee’s representative

Date of filing

Complainant, please note:

A complaint form that is incomplete in any material way may be dismissed, but may be re-filed

with all the required information if the re-filing is within the designated time for filing a complaint.

Attach to this form any documents you believe will support the complaint. If unavailable when

you submit this form, they may be presented no later than the Level One conference. Please

keep a copy of the completed form and any supporting documentation for your records.

Legal Policy 600.200; Board Policy 600.200; Legal Policy 300.120; Board Policy 300.120

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Parent category: Legal