SOP_NUMBER: 104.43-att-1
TITLE: Complaint Form
REFERENCE_CODE: IV012-0001
DIVISION: Administrative & Finance
TOPIC_AREA: 104 Policy-HR Complaint/Resolution/Review
EFFECTIVE_DATE: 2018-05-31
WORD_COUNT: 174
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/122364
URL: https://gps.press/sop-data/104.43-att-1/

SUMMARY:
This is the official Georgia Department of Corrections complaint form that employees use to file formal complaints against other employees or supervisors. Employees must provide their personal information, details about the complaint including when the problem occurred, how it has affected their employment, and what relief they are requesting. Completed forms must be submitted to the Agency Complaint Resolution Coordinator and are retained for a minimum of two to four years depending on the nature of the complaint.

KEY_TOPICS: employee complaint form, complaint filing, HR complaint, employment complaint, personnel complaint, discrimination complaint, harassment complaint, complaint resolution, SPBR violation, SOP violation, employee grievance, complaint procedures, agency complaint resolution

ATTACHMENTS:
  1. Complaint Form
     URL: https://gps.press/sop-data/104.43-att-1/
  2. Official Policy Statement - Employee Complaint Resolution Procedure
     URL: https://gps.press/sop-data/104.43-att-2/

========================================================================
FULL TEXT:
========================================================================

SOP 104.43
Attachment 1

5/31/18


Georgia Department of Corrections

Complaint Form


Employee Name Employee ID#


Complete Home Address
Street Name, Apartment#, or P. O. Box#


City State Zip


Job Title Home Phone


Facility/Office Work Phone


Name and Job Title of person against whom complaint is being filed:


Date the problem occurred or when you first became aware of the problem:


Employee complaint (attach additional sheets as needed):


If Complaint involves interpretation or application of a State Personnel Board Rule [SPBR] or
a Standard Operating Procedure [SOP], then specify the rule(s) or procedure(s):


How has your employment been unfavorably affected by this problem?


Relief Requested:


Employee Signature Date


Mail original copy of this Complaint Form, with any attachments, to:


**Agency Complaint Resolution Coordinator**

**Central HR/Gibson Hall/2** **[nd ]** **Floor**

**P. O. Box 1529**
**Forsyth, Georgia 31029**

**(478) 992-5204**


Retention Schedule: Upon completion, this form shall be retained by the Agency Complaint Resolution Coordinator for a minimum of four (4) years
for Complaints alleging discrimination or harassment based on race and a minimum of two (2) years for all other Complaints.