COMPLAINT FORMS

The following forms are provided to assist the District in processing employee complaints on levels one, two, and three.

Exhibit A: Employee Complaint Form: Level One 1 page

Exhibit B: Supervisor/Administrator Report of Level One Conference 1 page

Exhibit C: Notice of Appeal: Level Two 1 page

Exhibit D: Notice of Appeal to the Board: Level Three 1 page

EXHIBIT A

EMPLOYEE COMPLAINT FORM: LEVEL ONE

Any employee filing a complaint must fill out this form completely and submit it to his or her principal or immediate supervisor. All complaints will be processed in accordance with DGBA (LEGAL) and (LOCAL) or any exceptions outlined therein.

1. Name ______________________________________________________________________

2. Position/campus______________________________________________________________

3. Please state the date of the event or series of events causing the complaint._______________

___________________________________________________________________________

4. Please state your complaint, including the individual harm alleged. ______________________

___________________________________________________________________________

5. Please state specific facts of which you are aware to support your complaint (list in detail).

___________________________________________________________________________

6. Please state the remedy you seek for this complaint. _________________________________

___________________________________________________________________________

__________________________________________
Employee Signature

____________________________
Date Submitted

(Return to beginning.)

EXHIBIT B

SUPERVISOR/ADMINISTRATOR REPORT OF LEVEL ONE CONFERENCE

1. Complainant's name ________________________________________________________

2. Position/campus ___________________________________________________________

3. Date and time of conference __________________________________________________

4. Set forth the facts as presented by the complainant. _______________________________

_________________________________________________________________________

5. In your opinion, were the allegations made in the original complaint adequately supported by

facts submitted? _______ Yes _______ No

Please explain: ____________________________________________________________

_________________________________________________________________________

6. In your opinion, is the remedy sought by the complainant justified by the facts submitted?

_______ Yes _______ No

Please explain: ____________________________________________________________

_________________________________________________________________________

7. What decisions were made or recommendations agreed upon as a result of the conference?

_________________________________________________________________________

__________________________________________
Signature of Supervisor/Administrator

__________________________
Date

Attach a copy of the complainant's original written complaint (Exhibit A) and a copy of the written response from the supervisor/administrator before submitting.

Received by

__________________________________________
Superintendent

__________________________
Date

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EXHIBIT C

NOTICE OF APPEAL: LEVEL TWO

This form must be filled out completely by an employee appealing a Level One decision to the Superintendent or designee in accordance with the District's policies DGBA (LEGAL) and (LOCAL) or any exceptions outlined therein.

1. Name____________________________________________________________________

2. Position/campus ___________________________________________________________

3. To whom did you last present your complaint?____________________________________

Date of conference _________________________________________________________

4. If you will be represented in pursuing your complaint, please identify the individual or organization representing you.

Name _______________________________________________

Address _______________________________________________

_______________________________________________

Telephone (____) _________________________________________

Additional representatives, if any:

_____________________________________________

5. Attach a copy of the original complaint.

6. Attach a copy of the Level One decision being appealed.

__________________________________________
Employee Signature

__________________________
Date Submitted

(Return to beginning.)

EXHIBIT D

NOTICE OF APPEAL TO THE BOARD: LEVEL THREE

This form must be filled out completely by an employee appealing a Level Two decision to the Board, in accordance with the District's policies DGBA (LEGAL) and (LOCAL) or any exceptions outlined therein.

1. Name____________________________________________________________________

2. Position/campus ___________________________________________________________

3. To whom did you last present your complaint?____________________________________

Date of conference _________________________________________________________

4. If you will be represented in pursuing your complaint, please identify the individual or organization representing you.

Name _______________________________________________

Address _______________________________________________

_______________________________________________

Telephone (____) _________________________________________

Additional representatives, if any:

_____________________________________________

5. Attach a copy of the original complaint and the Level One and Level Two decisions.

__________________________________________
Employee Signature

__________________________
Date Submitted

(Return to beginning.)