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:

Name, Title of Grievor: *

Enter Full Name and Title

Organization:

Organization: *

Enter Full Organization Name:

Phone:

Phone: *

Country Code Area Code Phone Number

Email:

Email: *

example@example.com

Date Grievance Submitted :

Date

Name of Carbon Project or Company Grievance is against: *

Please indicate the Interest Group(s) you most closely represent: *

Economic Interests Social Interests Environmental Interests Forest Agencies Research Institutes and Universities Other:

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): *

Yes No

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

Yes No

Details of Event Leading to Grievance

Date, Time, and Location of Event:

Date, Time, and Location of Event: *

Witnesses (if applicable):

Witnesses (if applicable): *

Account of Event:

Account of Event: *

Provide a detailed account of the occurrence. Include the names of any additional persons involved.

Violations:

Violations: *

Provide list of any laws, policies, customs or guidelines you believe have been violated in the event described.

Proposed Solution:

Proposed Solution: *

Signature: *

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

Date *

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.