Independence Again
2435 Oak Park Drive Cookeville, TN 38506 - Independence Again North
224 Garrett Ave. Cookeville, TN 38501 - Independence Again West
255 Kacie Ave. Cookeville, TN 38501 - Independence Again Central
Phone: 931-933-5914 - Fax: 931-283-2680
EMail: inagaintn@gmail.com
Web: IndependenceAgain.org
Independence Again
Policy and Procedure Directive
Title: Consumer Grievance Policy#: Gr-001
Standard: Admit Information Service Area: Residents File
Effective Date: 7/18/2016 Revised: 10/02/2020
Residents are entitled to participate in the program activities without undue stress and conflict. Independence Again understands that residents may have occasional problems or issues affecting their program-related activities and it is important to resolve these as soon as possible. Should a conflict, irresolvable difference , or confrontation occur with an employee, volunteer or a support provider residents are encouraged to take the following steps.
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Employees/Resident Signature Date
Independence Again
Consumer Grievance
Date of Incident: _________________ Date of Completion of Form: _________________
Person(s) involved in the incident: _________________________________________________
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Description of incident: Be specific, include location, date, time and witnesses who were present.
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How would you like this to be resolved? ____________________________________________________________________________________________________________________________________________________________
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Employees/Resident Signature Date
Return this form to: Lynda Loftis-Webb at Lynda@IndependenceAgain.org
*** To be completed by staff: describe process of resolvolving the grievance:
What was the grievable offence: _____________________________________
What informal resolution steps were taken: _____________________________
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