Grievance Redress Mechanism Lodging Form

GRIEVANCE REDRESS MECHANISM LODGING FORM

1. Grievance Recording Desk

Project level

Ward Committee

County Level

Other (Please describe below)

Please describe

Name of Person Raising Grievance: (information is optional and always treated as confidential)

Gender

ID No

Age

Postal address

Occupation

Member of Vulnerable/Minority Group

Yes

If yes, describe

Phone

Ward/ Village

Disability

Yes

If yes, type of disability

Location where grievance/problem occurred (write in)

County

Sub County

Ward

Location

Village

Category of Grievance

Environmental safeguards, social issues including gender, labor and resettlement

Grievances regarding the misuse of funds/lack of transparency, or other financial management concerns

Reports of force majeure

Grievances regarding violations of policies, guidelines and procedures

Grievances regarding abuse of power/intervention by project or government officials

Appreciation

Grievances regarding contract violations

Grievances regarding staff performance

Suggestions

Brief Description of Grievance or Inquiry: (provide as much detail and facts as possible)

Please include any other information that you consider relevant, other matters or facts, including supporting documents:

Supporting documents (if any)

Choose File

Do you request that identity be kept confidential?

Yes

2. Previous Efforts to Resolve the Complaint

Have you raised your complaint with the grievance mechanism of the County Climate Change Unit (CCU) or the WCCCU?

Yes

If YES, please provide the following: (• When, how and with whom the issues were raised. • Please describe any response received from and/or any actions taken by the CCU level grievance mechanism. Please also explain why the response or actions taken are not satisfactory.)

If NO, why not?

3. Information on Authorized Representative.

(If Authorized Representatives are not complainants themselves, their names will be disclosed as needed, in order to ensure transparency).

Name

Contact numbers

Position /Organization

Address

Gender

Please provide evidence of the authority to represent the complainant which must include the complainant’s signature.

Do you request that identity be kept confidential?

Yes

Has this matter been the subject of court proceedings? YES/NO

Yes

If NO, please give a brief summary of your complaint and attach all supporting documents (Indicate all the particulars of what happened, where it happened, when it happened and by whom)

Choose File

Place of Submission

Name/Signature of Complainant

Date

GRIEVANCE REDRESS MECHANISM LODGING FORM (CGTR-FORM 04)