Grievance Log Form

The Grievance Log is the internal record [Company] staff complete every time a grievance is received. One entry is created per grievance and the log gives the Grievance Procedure its audit trail from intake through final disposition.

The Grievance Log Form on the right captures the log entry number, date the complaint was received, method of receipt (in person, phone, email, written, or other), the complainant’s identifying information and relationship to the client, the client name when different, the complainant’s contact information, a description of the complaint, any immediate action taken, the investigation summary, and the resolution or final disposition with date.

Follow-up requirements and the follow-up plan are recorded when applicable. The staff member receiving the complaint and, when applicable, the supervisor reviewing it sign and date the log entry. The grievance and all related documentation are maintained in accordance with agency record-keeping policies.