Internal Complaint Form Complainant Name First Last Date of complaint submission MM slash DD slash YYYY Person/Situation that the complaint relates to Code of Conduct/Issue that the complaint relates toDiscriminationHarassmentViolenceGossip/Lack of DiscretionBreech of Confidentiality (SAR data, etc.)Respect for workplace/staffLack of Kindness/ToleranceUse of property/assetsAlcohol or Drug UseFraud/TheftWorkplace Safety- Covid SafetyOtherPlease describe the situation/issueWe may be in contact directly to gather more information from you. The Land Between believes in deliberative dialogue and focusing on behaviours or situations rather than on individuals. Regardless of your preferences for being involved in our subsequent follow up on this complaint, you will be notified about the actions taken and outcomes/decisions. Please let us know if you want to be part of the investigation and intervention/deliberative dialogue. I would like to be involved in resolving the issue with the other party/parties involved I would like to remain anonymous I would like to be notified of the outcome in writing Internal Complaint Form _Managerial Issue Complainant Name First Last Date of complaint submission MM slash DD slash YYYY This form relates to complaints about Leora Berman, COO. Code of Conduct/Issue that the complaint relates toDiscriminationHarassmentViolenceGossip/Lack of DiscretionBreech of Confidentiality (SAR data, etc.)Respect for workplace/staffLack of Kindness/ToleranceUse of property/assetsAlcohol or Drug UseFraud/TheftWorkplace Safety- Covid SafetyOtherPlease describe the situation/issueWe may be in contact directly to gather more information from you. The Land Between believes in deliberative dialogue and focusing on behaviours or situations rather than on individuals. Regardless of your preferences for being involved in our subsequent follow up on this complaint, you will be notified about the actions taken and outcomes/decisions. Please let us know if you want to be part of the investigation and intervention/deliberative dialogue. I would like to be involved in resolving the issue with the other party/parties involved I would like to remain anonymous I would like to be notified of the outcome in writing
