GRIEVANCE INVISTGATION FORM

Date of Receiving Grievance: Date of Investigation:

Location: Grievance Reported by:

Grievance Reported to: Method of Grievance:

Description of the Issues

Interview summary and list of all persons involved with the grievance

Summary of findings

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Actions Done:

Proposed Closure Actual Closure Status

# Action Items Action Party
Date Date Open/Closed

10

11

12

13

List other relevant information/documentation

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Report prepared by: (Name/title) Date:

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