AGP2 Compliance Filling and Closing Form/Template

Forum A፡ AGP2 Compliance Filling Form

Date……………………………

1. Name of Compliant Presenter……………………… Sex………………………

Age………………… Education Level……………………

2. Address of Complaint Presenter:

Region……………………Zone…………………Kebele…………………….Sub-kebele/

village …………… Tel.…………………

3. Name of Specific Project for Compliance………………………………………………….

4. Type of the Complaint

…………………………………………………………………………………………………
…………………………………………………………………………………………………
………...………………………………………………………………………………
5. Cause of the Complain (from complaint presenter perspective)
…………………………………………………………………………………………………
…………………………………………………………………………………………………
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6. The need of Compliant Presenter (what compliant needs to be done for him/her)
…………………………………………………………………………………………………
…………………………………………………………………………………………………
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7. Committee member responsible for Handling the Complaint

Name…………………………… Tel. ……………………

8. Expected date to give solution፡ ……………………

9. Name of Compliant Recorder……………………Signature…………..Date……………..

10. Name and signature of Compliant Presenter

Name ……………………Signature…………..Date……………..

Kebele Stamp …………………………

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Form B፡ AGP2 Compliance Closing Form

Date……………………………

1. Name of Complainer Whose Issue is Resolved ………………………

Sex……………………… Age……………………… Education Level……………………

2. Address of Complaint Presenter:

Region……………………Zone…………………Kebele…………………….Sub-kebele/

village …………… Tel.…………………

3. Name of Specific Project…………………………………………………….

4. Type of Compliant Solved

………………………………………………………………………………………………………
……………………………………………………………………………………………………...
5. Decisions Reached (Issue solved or Referred to legal Court System)
………………………………………………………………………………………………………
……………………………………………………………………………………………………...
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6. Opinion of Compliant Presenter about the Decision
………………………………………………………………………………………………………
………………………………………………………………………………………………………
7. Days Taken to Address the Complaint፡ ……………………

8. Name of the Person to Whom Compliance Solved……………………………

Signature………………..Date………………..

9. Grievance Redress (Mediation) Committee Members

Name Signature

1. …………………………………… ……………

2. …………………………………… ……………

3. …………………………………… ……………

4. …………………………………… ……………

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 Kebele Stamp …………

የኤጂፒ (AGP) የቅሬታ ማቅረቢያ እና መዝጊያ ቅጾች

ቅፅ ሀ፡ የኤጂፒ (AGP) የቅሬታ ማቅረቢያ ቅፅ

ቀን……………………………

11. የቅሬታ አቅራቢ ስም……………………… ጾታ……………………… እድሜ…………………

የት/ት ደረጃ……………………

12. ቅሬታ አቅራቢ የሚገኝበት ቦታ፣

ወረዳ……………………ቀበሌ…………………….ጎጥ…………… ስልክ ቁ.…………………

13. ቅሬታው የቀረበበት ንዑስ ፕሮጀክት ስም…………………………………………………….

14. የቀርበው ቅሬታ አይነት

…………………………………………………………………………………………………
…………………………………………………………………………………………………
………...………………………………………………………………………………
15. የችግሩ መንስኤ (በቅሬታ አቅራቢው አስተያየት)
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
16. የቅሬታ አቅራቢው እንዲሆንለት የሚፈልገው ፍላጎት
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
17. ከኮሚቴው ማሀከል ቅሬታውን እንዲፈታ ሃላፊነት የተሰጠው(የሚከታተለው) ሰው

ስም…………………………… ስልክ ቁ. ……………………

18. ቅሬታውን ለመፍታት የሚወስደው ቀን ብዛት፡ ……………………

19. የቅሬታ ተቀባይ ስም…………………………ፊርማ…………..ቀን……………….…………..

20. የቅሬታ አቅራቢ ስም…………………………ፊርማ…………..ቀን……………….…………..

 የቀበሌው ማህተም …………………………

ቅፅ ለ፡ የኤጂፒ (AGP) የተፈታ ቅሬታ መዝግ ቅፅ

ቀን……………………………

10. ቅሬታው የተፈታለት ሰው ስም……………………… ጾታ………………………

እድሜ……………………… የት/ት ደረጃ……………………

11. የሚገኝበት አድራሻ፣

ወረዳ…………………….. ቀበሌ……………………….ጎጥ………………… ስልክ ቁ.…………………

12. ቅሬታው የቀረበበት ንዑስ ፕሮጀክት ስም…………………………………………………….

13. የተፈታው ቅሬታ አይነት

………………………………………………………………………………………………………
……………………………………………………………………………………………………...
14. በቅሬታ የተሰጠው ውሳኔ (ችግሩ ተፈቷል፣ ወደ ፍርድቤት ተመርቷል)
………………………………………………………………………………………………………
……………………………………………………………………………………………………...
………………………………………………………………………………
15. የቅሬታ አቅራቢው ስለቅሬታ አፈታት ያለው አስተያየት
………………………………………………………………………………………………………
………………………………………………………………………………………………………
16. ቅሬታውን ለመፍታት የወስደው ቀን ብዛት፡ ……………………

17. ቅሬታው የተፈታለት ሰው ስም…………………………… ፊርማ………………..ቀን………………..

18. የቅሬታ ሰሚ አባት ስምና ፊርማ

ስም ፊረማ

5. …………………………………… ……………

6. …………………………………… ……………

7. …………………………………… ……………

8. …………………………………… ……………
 የቀበሌው ማህተም …………………………

Grievance Redress Mechanism Reporting Format

Quarter________ Year______

Target Achie
No Annual
Activity Unit Up to this This
. target This quarter Up to this
quarter quarter
Monitoring and No of
1
technical support woreda          
Awareness creation Male          
2 to community, Female          
KDC, DA Total          
Established and No of
3
functional GRM woreda          

Number of
4 No.
grievance registered
         
Number of
5 No.
grievance resolved          
         
Types
Types of cases          
6 of
appealed
cases