A Safe Place Participant Grievance Form

This sample grievance form was developed by A Safe Place and includes a one-page overview that articulates the importance of having open communication and addressing concerns. The remainder of the document contains a two-page form where the participant may document their concern, whether or not they have discussed it with a staff member, how they think the situation could have been handled differently, and what they wish the outcome of their grievance to be. This template resource can be adapted by Family Justice/Multi-Agency Centers who are developing a Grievance Policy.