Grievance Investigation Form - Government of New York
Date of Investigation: Inmate’s Name:
Facility: Facility Grievance Number:
Description of the issues Supplement attached ( )
Interview summary and list of all persons involved with the grievance Statements attached ( )
Summary of findings Supplement attached ( )
List other relevant information/documentation Supplement attached ( )
Report prepared by
(Date)
Printed Name: Signature:
................
................
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