Zimmfor - Grievance Submission Form

Instructions: Please provide feedback relating to project planning and/or implementation via the (Stakeholder Consultation Feedback Form ). Grievance Submission Form is only to be used should a dispute arise based on action (or inaction) resulting from the feedback contained in the Stakeholder Consultation Feedback Submission Form. Thank you!
Grievance
Submission Form
Name, Title of Grievor:*
Enter Full Name and Title
Organization:*
Enter Full Organization Name:
Phone:*

Country CodeArea CodePhone Number
Email:*
example@example.com
Date Grievance Submitted :

MonthDayYear
Date
Name of Carbon Project or Company Grievance is against:*
Please indicate the Interest Group(s) you most closely represent:*

Economic InterestsSocial InterestsEnvironmental InterestsForest AgenciesResearch Institutes and UniversitiesOther:
If applicable, Indicate Other Interest Group(s):
If applicable, Indicate Other Interest Group(s):
Can we publish your Grievance (removing sensitive information such as name, and contact information):*

YesNo
Can we contact you to follow-up on your feedback:*

YesNo
Details of Event Leading to Grievance
Date, Time, and Location of Event:*
Witnesses (if applicable):*
Account of Event:*
Provide a detailed account of the occurrence. Include the names of any additional persons involved.
Violations:*
Provide list of any laws, policies, customs or guidelines you believe have been violated in the event described.
Proposed Solution:*
Signature:*

Clear
As the grievor, your signature above indicates that the information you have provided on this form is truthful.
Date*

MonthDayYear
Date
Please retain a copy of this completed form for your records. If you submitted this form through the Zimmfor Management Services Ltd. website, a copy of this form will be emailed to the address provided.

To ensure the most efficient handling of grievances, and effective responses to them, grievors are encouraged to be:
- Judicious – please be discerning in the amount of grievances made. For example, if you have similar grievances on multiple topics it is best to combine them.
- Constructive – please submit a grievance with the aim to reach resolution. For example, propose solutions to the impacts you are experiencing.
Should be Empty: