MEMBERS NAME______________________________________ DOG TAG#___________________
PARK RANGER’S or LEADERSHIP TEAM MEMBER’S name: ________________________________
Describe the incident or action being appealed: ____________________________________________
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Date of incident/action: _______________________________________________________________
Member ‘s proposed remedy: __________________________________________________________
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Member’s Signature: ____________________________Date_________________________________
Date Step 1(verbal discussion with Ranger or Leader) was completed:__________________________
Ranger/Leader’s response:____________________________________________________________
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Ranger/Leader’s signature: ___________________________Date of Step 1 response:_____________
Ranger/Leader’s response to this appeal:_________________________________________________
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Ranger/Leader’s signature: ____________________Date of Step 2 response:___________________
I have read the Ranger/Leader’s response and I have decided to: (circle one)
Accept the step 2 response Appeal to Leadership Chair Appeal to Peer review Panel
I hereby authorize the Peer Review Panel or Leadership Team to review all information which may be relevant to the proper investigation of my appeal. I expect this information will be held in strictest confidence. I realize that the decision made by the Leadership Team or by the Peer Review Panel is final and binding. I further understand that the Peer Review Panel cannot change policy, park rules and/or City of Danville Rules or Policy.
Signature: ______________________________Date:__________________________________
Leadership Team 6/2012