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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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