Employee Complaint Form - Level One printable pdf download

Employee Complaint Form - Level One

Date Received ___________ Initials _____

Employee Complaint Form – Level One

To file a formal complaint, complete this form in its entirety and submit by hand delivery, fax, or U.S.

mail to the appropriate administrator within the time frame established in Board Policy DGBA (Local).

All complaints will be heard in accordance with DGBA (Legal) and (Local).

1. Name _____________________________________________________________________

2. Address ___________________________________________________________________

_________________________________ Telephone # (_____) _________________

3. Position _______________________ Campus/Department __________________________

4. Will you have a representative present at the Level One hearing? Yes _____ No _____

5. If you answered yes, please identify your representative.

Name ______________________________________________________________________

Address _____________________________________________________________________

__________________________________ Telephone # (_____) __________________

6. Describe the circumstances or decision causing your complaint. Cite specific, factual details.

______________________________________________________________________________

7. List the date(s) of the circumstance(s) or decision causing your complaint.

____________________ ___________________ ____________________

Level One Employee Formal Complaint Form

Employee Complaint Form - Level One