Employee Grievance Incident Report Form



Directions: If you believe that you have been subjected to alleged inequity as it applies to Board Policies, System President’s Procedures, or College Procedures, you are required to fill out this incident report form. The College can only base its decision and take actions based on the information provided by you. If more space is necessary, please continue your comments on the back of this form, or on a separate sheet of  paper.

Date of Complaint(Required)
Name (Complainant)(Required)
If you have a Student ID Number (S#) please enter here.
Is the person(s) an:(Required)

Drop files here or
Max. file size: 50 MB.
    We highly encourage attempting to resolve complaints informally. Would you be interested in attempting this process? Choose one:(Required)


    To investigate your grievance, it will be necessary to interview you, the alleged Respondent, and any witnesses with knowledge of the allegations or defenses. The statements and the information that you are providing may be attributed to you and could be included in any grievance reports that are prepared.
    Authorization to disclose identity of Complainant:(Required)
    *Please note limiting the college's ability to disclose will affect the college's ability to respond to the grievance.