EMPLOYEE COMPLAINT FORM
USM Office of Campus Environmental Safety & Health
INDIVIDUAL LODGING THE COMPLAINT: _________________________________________
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DATE: ______________________________
BUILDING LOCATION: _____________________________
ROOM/LAB: ___________________
PHONE EXTENSION:
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NATURE OF COMPLAINT:
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INDIVIDUAL RECEIVING THE COMPLAINT: ___________________________________________
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INVESTIGATION PROCEDURE: _______________________________________________________
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CORRECTIVE ACTION TAKEN: ________________________________________________________
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FOLLOW-UP PROCEDURE: ____________________________________________________________
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