GRIEVANCE CLOSE OUT FORM

GENERAL
Project
Case #
Complainant full Name
Type of issue Complaint Suggestion Concern
(mark with X).

ACTION FOR RESOLUTIONS

Resolutive action and ACTION TARGET DATE
timeframe

Justification for the action

CONCLUSIONS (This section is completed upon completion of all agreed actions)

Action Implementation
Date
Complainant Satisfied with Yes No
Process
Comments

Complainant Satisfied with Yes No

Outcome
Comments

Complainant Signature on
Complaint Close Out ____________________________ Date _________________

Grievance Owner
Signature on Complaint ____________________________ Date _________________
Close Out

Date: _______________________________
Please return this form to:
Site Social / Grievance Officer

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