"Incident/Complaint Disposition Form" - Florida

The Florida Department of Juvenile Justice has released this version of the "Incident/Complaint Disposition Form" on October 1, 2008.

This form may be used by all Florida residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Incident/Complaint Disposition Form" - Florida

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DEPARTMENT OF JUVENILE JUSTICE
OFFICE OF THE INSPECTOR GENERAL
BUREAU OF INVESTIGATIONS
INCIDENT/COMPLAINT DISPOSITION FORM
IDENTIFYING DATA
This Section To Be Completed By The Office of The Inspector General
Case #:
Branch/Region/Circuit:
Program/Facility/Unit:
Subject’s Name:
Position/Status:
Synopsis of Allegation(s)/Description of Problem(s):
DISPOSITION OF CIVIL RIGHTS ALLEGATIONS
This Section To Be Completed By The Bureau of Personnel
Cause to believe alleged harassment/discrimination occurred (explain below)
No Cause to believe alleged harassment/discrimination occurred
Cause to believe other misconduct occurred (explain below)
Comments:
[The EEO Officer must specifically list the allegation(s) of discrimination or harassment on which
cause was determined or the other misconduct on which cause was determined by the Resolution Panel].
(Attach additional sheets if necessary)
Signature of EEO Officer
Date
1
Revised 10/08
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DEPARTMENT OF JUVENILE JUSTICE
OFFICE OF THE INSPECTOR GENERAL
BUREAU OF INVESTIGATIONS
INCIDENT/COMPLAINT DISPOSITION FORM
IDENTIFYING DATA
This Section To Be Completed By The Office of The Inspector General
Case #:
Branch/Region/Circuit:
Program/Facility/Unit:
Subject’s Name:
Position/Status:
Synopsis of Allegation(s)/Description of Problem(s):
DISPOSITION OF CIVIL RIGHTS ALLEGATIONS
This Section To Be Completed By The Bureau of Personnel
Cause to believe alleged harassment/discrimination occurred (explain below)
No Cause to believe alleged harassment/discrimination occurred
Cause to believe other misconduct occurred (explain below)
Comments:
[The EEO Officer must specifically list the allegation(s) of discrimination or harassment on which
cause was determined or the other misconduct on which cause was determined by the Resolution Panel].
(Attach additional sheets if necessary)
Signature of EEO Officer
Date
1
Revised 10/08
Save As
Reset/Clear Form
Print Form
Email Form
ACTION TAKEN BY MANAGEMENT (EMPLOYEES)
This Section to Be Completed By Appropriate Official After Conferring With General Counsel’s Office
Subject Employee (Name and Title):
Disciplinary Action:
Counseling
Reprimand
Suspension
Termination
Resignation
None (Must be Explained Below)
Other
Date Disciplinary Action Occurred:
Comments:
Action Authority (Name and Title):
(Attach additional sheets if necessary)
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Print Form
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2
Revised 10/08
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