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Grievance Form

The Council on Aging of Etowah County, Inc.

          Grievance Report

When a staff member, volunteer, or client fails to reach an informal agreement with his/ her supervisor or staff member regarding a grievance, he/ she has the right to meet with the Executive Director.  If, after meeting with the Executive Director, no resolution is reached, the worker has a right to file a formal, written report with the Executive Director to request a hearing with the Executive Committee.

All formally presented complaints should be outlined in this Grievance Report form.  Complete all sections: 

Date:  ______________________________________

Name:  ___________________________________________________

Position/Title/:  ____________________________________________

Supervisor:  _______________________________________________

Description of adverse action causing the grievance:

I first reported this problem on:  _______________________________________________________

Steps I have taken to solve the problem:  ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


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