The attached form was developed as a tool
for you to address problems you may encounter in your role as a PEIR facilitator. This form was designed to
address issues with health care providers, other PEIRs, your manager or Local as it relates to your role as a PEIR facilitator.
The Committee on Substance Abuse is always looking at ways to support your
efforts as a PEIR facilitator and offers this as a means to resolve issues.
When filling out this form please be as specific and concise as possible with names, dates, and any other pertinent information.