P.E.I.R. Problem Solving – Resolution		Date: ______

1.	Briefly describe the incident.
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2.	Describe the actions of the person(s), facility, or organization you are concerned about.
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3.	Describe the preferred resolution.
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4.	What action do you suggest would bring about a more satisfactory resolution?
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Email the completed form to Sue Head, P.E.I.R. Coordinator at: shead@cwa7019.org

Date Received: _________________________________________________________________

Reviewed by: __________________________________________________________________

Date referred t o S.A.C: __________________________________________________________

Resolution: ____________________________________________________________________	 ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Last updated December 19, 2014)