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Ministry of Economy
EZ-KAR Project

Grievance Registration Form

Gender
Male Female
Type
IDP Returnee Host
Complaint by:
Individual Community

Grievance Uptake Channel: please select one option only

Complaint Box
Letter/Form
Telephone
Project Staff
Email
Website
Personal Visit
Social Media

Classification of Grievance: please select one option only

Complaint
Comment
Suggestion
Do you request that identity be kept confidential?
Yes No

Grievance Issue:

Disputes between hosts and returnees
Construction Problems
CDC Formation
Land acquisition and Compensation
Hygiene and health issue
Water Quality
Sanitation
Passport application problems
Dispute with Contractors
Inter-Community dispute
Technical/Operational Coordination
Process Delays
Noise
Labor Influx
Safety Issue
Information Issue
Other (Please Spacify below)

Explanation of grievance:

What is the perceived cause?

Suggested action to address grievance:

Note: “The EZ-KAR Management would like to assure you that we are treating the communication with you with the utmost confidentiality. We will not disclose the information you have provided to us. At the same time, we ask you that you do the same and do not disclose the information concerning communication with EZ-KAR to anybody. This helps preserve the integrity of our investigations.
Thank you for bringing this matter to our attention.”