Community Action Of Orleans & Genesee Employee Complaint Form

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Community Action of Orleans & Genesee
Employee Complaint Form
Employee Name:
Program/Department:
I would like to utilize the agency’s complaint resolution procedure for the reason explained below:
The problem I am bringing to your attention is: ( be specific, dates, events, etc)
The action I am asking the agency to take is:
Employee Signature:
Date:
Policy Reference: Employee Handbook – Section 1401
If desired and requested, the following staff are available to assist with the Complaint Resolution
process and/or to answer any questions you may have.
Diane Bechteler – Agency EEO Officer (for complaints discriminatory in nature)
589-5605
Diane Bechteler – Payroll and Benefits Administrator
589-5605
Carol Berray - Head Start Human Resources/Administrative Services Manager
589-5683

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