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Tuolumne COE |  E  1312.1  Community Relations

Complaints Concerning District Employees   

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EMPLOYEE COMPLAINT FORM

1. Before filling out this complaint form, you should read the Board policy and administrative regulation on personnel-related complaints, attached. You should also meet with the employee with whom you have a complaint and see if the problem can be resolved and discuss the complaint with the employee and the employee's supervisor. If the complaint cannot be resolved, then fill out this form and submit it to the employee's supervisor, who will date it according to when it was received. If the complaint, after review by the supervisor, remains unresolved, the supervisor will refer the written report to the County Superintendent.

2. You will receive a written reply within 15 working days from the County Superintendent, unless the complaint is resolved prior to that time.

Date incident happened _______________________________________________________

Name of each employee involved _______________________________________________

___________________________________________________________________________

Give a brief, but specific, summary of the complaint and the facts surrounding it sufficient to inform the employee's supervisor and the employee of the precise nature of the complaint:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Signed ___________________________________

Dated ____________________________________

Date received by Supervisor: _______________________________

Date referred to County Superintendent: ____________________________

Date County Superintendent's reply is due: __________________________

Exhibit TUOLUMNE COUNTY SUPERINTENDENT OF SCHOOLS

version: May 30, 2008 Sonora, California