Grievance and Appeal Form (P&P)

IDAHO DEPARTMENT OF CORRECTION
Grievance and Appeal Form
Offender's Name: IDOC Number:
Check the appropriate box. I am filing ❑ a grievance. I am filing ❑ an appeal.
If I am filing an appeal, the associated grievance number is:
Offender Section
The problem is: (Write or type a brief description of your issue. Do not exceed this page. Do
not submit attachments. You can only grieve one issue per form).
I have tried to solve this problem informally by:
I suggest the following solution for the problem:
Offender's Signature: Date:
Note: When sent via email, the form may be accepted without a signature.
For Administrative Use
District: Date Grievance/Appeal Received:
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Grievance Number: Date Answer Due:
Grievance Category: Date Answer Received:
Appendix B
316.04.01.001
(Appendix last updated 2/14/11 )