EAP Grievance Form
A grievance reflects a concern or dissatisfaction with a certain project such as: dispute over land or access, perception of unfair treatment, deviation from major policy or procedures, disturbance to environment and cultural circumstances or an event perceived to cause harm to a person’s livelihood, health or property.
1. Complainant Information
If you wish to remain anonymous do not complete items 1.1-1.5

1.1 Name of Complainant
1.2 Complainant relationship to EAP
1.4 Complainant Telephone
1.5 Complainant Address
2. Statement of Grievance
2.1 Name of individuals involved *
2.2 Date grievance occurred *
2.3 Location where grievance occurred *
2.4 Please write the nature of all facts of the grievance (what happened before, during and after, why the grievance happened, etc.) *
3. Legal, Contract, Policy or Procedural Violation
Please list which law, contractual clause, policy or procedure was violated (if any)

4. Remedy Sought
Please write what remedy you would propose (if any).

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