Da Form 7279 - Eo Complaint Form (Page 2 of 2) in pdf

10a. ACKNOWLEDGEMENT.

I acknowledge receipt of this complaint, on behalf of (complainant's name)

submitted to me by (name, rank, alternative agency)

. I understand I have 14 calendar days (3 weekend drill periods for

Reserve components) in which to initiate an investigation into the complaint, implement a plan to prevent reprisal, complete the

investigation, and inform the complainant of the results of that investigation. All formal complaints will be reported within 72 hours

to the first GCMCA in the chain of command.

10b. NAME

10c. GRADE

10d. DATE (YYYY/MM/DD)

10e. ORGANIZATION

10f. SIGNATURE

PART II - RESULTS OF INVESTIGATION

11a. I (name of commander)

reviewed the report of investigation into

your allegations. I

concur

nonconcur with the findings of the investigating officer. I find that your allegations are:

substantiated

unsubstantiated. I base my decision on the following points:

11b. SIGNATURE OF COMMANDER

11c. DATE (YYYY/MM/DD)

PART III - ACTIONS TO RESOLVE COMPLAINT

12a. The command has done (or will do) the following actions to resolve this complaint and continue to prevent acts of reprisal:

12b. ADVISEMENT TO COMPLAINANT: You have the right to appeal these actions to resolve your complaint. You will have

7 days (next weekend drill for Reserve components) to submit your appeal in writing. If you elect not to appeal, your case is

considered closed. If you decide to appeal, state the basis of, or grounds for, your appeal in the space below. I will refer your

appeal to the appellate authority, who will review your case and provide you feedback when that review is completed.

12c. SIGNATURE OF COMMANDER

12d. DATE (YYYY/MM/DD)

12e. ACKNOWLEDGEMENT BY THE COMPLAINANT AND SUBJECT(S) OF THE COMPLAINT OF FINDINGS, FEEDBACK, AND

APPEALS OPTIONS

(Signature of Complainant)

(Date)

(Signature of Subject(s) of Complaint)

(Date)

FOR ADDITIONAL SUBJECT(S) OF COMPLAINT, USE A BLANK SHEET OF PAPER.

PART IV - APPEAL

13a. I elect to appeal the outcome of my complaint for the following reasons

Continuation sheet(s) is attached

Continuation sheet(s) is not attached

13b. COMPLAINANT'S SIGNATURE

13c. DATE (YYYY/MM/DD)

13d. I have reviewed the complaint file, the investigative findings, and other information regarding this case. My findings are:

13e. SIGNATURE OF APPELLATE AUTHORITY

13f. DATE (YYYY/MM/DD)

13g. I acknowledge being counseled concerning the outcome of this appeal.

13h. SIGNATURE OF COMPLAINANT

13i. DATE (YYYY/MM/DD)

PAGE 2, DA FORM 7279, DEC 2005

APD V1.00

Da Form 7279 - Eo Complaint Form Page 2

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