Grievance Form

Access Alaska Inc.

Grievance Form

 

 We encourage you to first discuss your concerns or complaints with the person who is directly involved with your concern. If you are uncomfortable with that, you may ask to speak to a supervisor. Also, you have the choice of completing this form, or phoning in your Grievance to either of the following people:

1. Human Resources Director (employee grievances)      1-907-263-1930

2.Compliance Officer (consumer/other grievances)          1-907-263-1938

Name

Phone number

Mailing Address

Indicate your relationship to Access Alaska Inc. Please check one of the following:

 Employee Consumer Other

DESCRIBE YOUR GRIEVANCE

If possible please include dates and full names

PLEASE READ AND SIGN BELOW

You may authorize another person to act on your behalf and this representative may use the Grievance process. You are not subject to any penalty for filing a Grievance.

If you need further information regarding the Grievance process, please call:

1. Human Resources Director (for employees) 1-907-263-1930

2. Compliance Officer (consumer/other grievances) 1-907-263-1938

For the purpose of resolving this Grievance, I authorize the following person to act on my behalf.

(Please write "n/a" if you will not have anyone acting on your behalf):

Name and phone number of representative:

I (name) understand that the Access Alaska employee designated to handle this Grievance will be authorized to contact myself or my representative (as named above) and any involved party in order to resolve my Grievance. Designated personnel will also be authorized to discuss any and all information that shall be needed to evaluate and resolve this Grievance. I have received a copy of this completed form

Signature

(Electronically entering your name here will be considered a legal signature)

Date ,

Notification will be sent to you that Access Alaska has received this form

When you have completed, signed and dated this form please mail to:

Attn: Grievance
Access Alaska Inc. / Compliance Officer
1217 E. 10th Ave.
Anchorage, AK 99501

You may submit electronically via the Website, or to this email:

Website address: accessalaska.org
Email address: grievance@accessalaska.org