FEDERATED STATES OF MICRONESIA

Programmatic Preparation Advance (PPA)

Stakeholder Engagement Plan (SEP)
DECEMBER 2020

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FSM PPA Stakeholder Engagement Plan

Contents
1

INTRODUCTION ................................................................................................................................................ 32

SUMMARY OF EXPECTED ENVIRONMENTAL, SOCIAL, HEALTH AND SAFETY IMPACTS ....................... 33

STAKEHOLDER ENGAGEMENT ACTIVITIES PRIOR TO DEVELOPMENT OF SEP ....................................... 3

4

STAKEHOLDER IDENTIFICATION AND ANALYSIS ......................................................................................... 3

5

6

4.1

Project Partners .......................................................................................................................................... 4

4.2

Project Affected Parties (PAPs) and Other Interested Parties .................................................................... 4

4.3

Disadvantaged/Vulnerable Individuals or Groups ....................................................................................... 4

STAKEHOLDER ENGAGEMENT....................................................................................................................... 4
5.1

Purpose and Timing of Stakeholder Engagement Program ........................................................................ 4

5.2

Proposed Strategy for Information Disclosure and Consultation................................................................. 5

5.3

Timelines..................................................................................................................................................... 6

5.4

Review of Comments .................................................................................................................................. 6

IMPLEMENTATION OF SEP .............................................................................................................................. 7
6.1

Roles and Responsibilities .......................................................................................................................... 7

6.2

Grievance Mechanism (GM) ....................................................................................................................... 7

6.3

Monitoring and Reporting............................................................................................................................ 77

Annex A. Project Commitment Registrar Template ............................................................................................. 88Annex B: Grievance (Complaint) Process for the FSM PPA .............................................................................. 9

Introduction ............................................................................................................................................................... 9
Overview ................................................................................................................................................................... 9
Eligibility Criteria for the GRM ................................................................................................................................. 10
Complaint/Grievance Report Form ......................................................................................................................... 10
GM Complaints Process ......................................................................................................................................... 11
How to Get in Touch ............................................................................................................................................... 12
Grievance Report Form ........................................................................................................................................... 132

FSM PPA Stakeholder Engagement Plan

1

INTRODUCTION
Federated States of Micronesia (FSM) has requesting access to funds from the World Bank
(WB) that will be used to prepare future WB projects within the FSM – the Programmatic
Preparation Advance (PPA). The funds will be used to prepare safeguards instruments, recruit
project managers, engage short term project specific professional international technicalAdvisors (individuals and firms) for inputs specifically related to project design and preparation
and FSM CIU consultants.
FSM will apply to draw down on the fund as and when required.
Work on the PPA falls under the World Banks (WB) Environmental and social Framework(“ESF”), which requires that FSM needs to prepare safeguards instruments for the activities
that could be funded under the PPA, these instruments are:•••Environmental and Social Commitment Plan (ESS1);
Stakeholder Engagement Plan (ESS10); andLabor Management Procedure (ESS2), which includes a labor Grievance Mechanism(GM).

This document is the Stakeholder Engagement Plan (ESS 10).

2

SUMMARY OF EXPECTED ENVIRONMENTAL, SOCIAL, HEALTH AND SAFETY IMPACTS
The activities for which the PPA is provided are generally administrative, principally officebased with in-country field site visits. These activities do not have external or third party
impacts, with the principal Environmental and Social risks relating to Occupational Health and
Safety (OH&S) and employment/recruitment risks relating to Labor Management. Activities
funded under the PPA will include project design works, policy review and preparation ofsafeguards instruments all of which will interact with stakeholders, throughout the FSM withthe possibility of adverse perceptions relating to cultural sensitivity or other communicationsrelated impacts.
OH&S and employment/recruitment risks are addressed in the Labor Management Plan (LMP).
This SEP focuses on cultural awareness and appropriate communications associated withstakeholder interactions as a main area of Project residual risk and includes a step by step
Grievance Mechanism (GM).

3

STAKEHOLDER ENGAGEMENT ACTIVITIES PRIOR TO DEVELOPMENT OF SEP
No consultation or disclosure activities have been undertaken to date.
disclosed on the DOFA and DCT&I websites.

4

The SEP will be

STAKEHOLDER IDENTIFICATION AND ANALYSIS
Stakeholder analysis determines the likely relationship between stakeholders and the Project
and assists to identify the appropriate consultation methods for each stakeholder groupduring the life of the project. The following four groups of stakeholders are identified for thisproject:••••

Project Partners;
People or groups likely to be affected by the project (project-affected parties);
Other interested parties that may have an interest in the project; andVulnerable segments of population.
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FSM PPA Stakeholder Engagement Plan

The identified groups are further described below. Stakeholder identification and analysis willcontinue throughout the Project cycle and will remain flexible and dynamic in its approach.

4.1

Project Partners
Project partners are defined as stakeholders that contribute to the execution andimplementation of the Project. Project partners identified for the PPA are:
•
•
•
•
•
•
•
•

4.2

National and State Government Ministries, Departments and Agencies;
Municipal and Local Government Agencies;
Traditional and Customary Leaders;
Civil Society including business entities;
Non Government Agencies (International, National, State and community, NGO’s etc);
The World Bank Regional Office;
Other development partner donors; andConsultants.

Project Affected Parties (PAPs) and Other Interested Parties
A number of PPA related activities will set the tone and direction for investment and will
potentially have direct or indirect impacts on communities and citizens. To mitigate the risk ofadverse impacts, stakeholder engagement will need to commence as soon as practicable,
involving stakeholders early on in all PPA funded studies and technical advisory stages, andadopting culturally appropriate and effective consultation techniques at the national and statelevels.

4.3

Disadvantaged/Vulnerable Individuals or Groups
At this stage it is not possible to identify specific disadvantage – vulnerable candidates,
however during all Project activities attention will be given to ensure the inclusion of women,
the elderly, youth, the disabled, and other vulnerable members of society in any stakeholder
engagement.

5

STAKEHOLDER ENGAGEMENT

5.1

Purpose and Timing of Stakeholder Engagement Program
The objective of PPA related stakeholder engagement is to disseminate information and raiseawareness about the Project that is being prepared and elicit input and advice from a rangeof stakeholders who may be affected by the Project or may have specific expertise in thesubject area. This information exchange will provide valuable information to:
•
•
•
•
•

Create and maintain confidence and trust;
Ensure local awareness, understanding and ownership;
Ensure a wide range of stakeholder groups are involved in the participation processes
and benefit distribution;
Provide avenues for conflict resolution by consensus; andDisseminate results and lessons learned to the wider community, including government(National and State), customary traditional leaders, business community and nongovernment agencies.

Stakeholder participation is expected to allow the Project to:•Relate better to the local context;4

FSM PPA Stakeholder Engagement Plan••••

Provide technical excellence;
Follow international good practice;
Harmonize with other development partners; andReflect a broad range of information and perspectives.

It is envisaged that two types of consultation scenarios are potentially associated with the
Project as described below:
Type of
Stakeholder
Consultation
Scenario 1:
Consultation on a
specific project
preparation funded
under the PPA.

Features of Stakeholder Consultation
•
•
•
•
•

Scenario 2:
Consultation to
inform a specificscope of works
funded by the PPA(e.g. policy review,
gender study,
concept deign ofinfrastructure etc).

•••

This will be a broader stakeholder consultation relating to the overall
project activities including broader project issues and potential impacts.
The aim of this consultation will be to provide overview information,with a focus on potential environmental and social issues and impacts
and associated mitigation measures.
The focus of this consultation should be on appropriate and sensitive
communication with the broader community and all project relevant
stakeholders.
Accurate and understandable analyses outputs such that stakeholder
issues relating to the project are objectively identified.
Typically carried out as part of the environmental and social assessment
work program and led by the CIU safeguards team or the environmental
and social consultants. Consideration of the delivery of all or part thereof
in a local language will be determined on a case by case basis.
The consultation will be narrower in range of stakeholders, focusing on
special interest groups and sectors associated with the Project.
A high level of pre-consultation information exchange and awarenesswill be necessary including delivery of information exchange undertakenwith appropriate recognition of cultural, traditional and gender based
sensitivities.
Typically led by the consultancy team as part of the technical advisory
work program with support from the CIU safeguards team; or may be ledby the CIU safeguards team if the consultants do not have the required
capacity. Consideration of the delivery of all or part thereof in a local
language will be determined on a case by case basis.

Principles of good stakeholder engagement practice will be observed in all PPA related
consultations specifically including protocols and mechanisms for consultation to ensure State,municipal, local traditions and culture values are respected.

5.2

Proposed Strategy for Information Disclosure and Consultation
A critical element in planning a participatory consultation strategy is the selection and use ofwide range of participation techniques to meet the Projects desired objectives. The following
participation techniques may be used to deliver PPA related consultations:
Information Dissemination, Sharing and Awareness: To inform and update stakeholders on
the PPA status, actions taken and results. This technique can be delivered through written(emails, fact sheets, newsletter, websites) or face to face methods (meetings, workshops
including virtual activities using the internet). For information dissemination to community
representatives, PPA will use culturally appropriate techniques and delivered in local languages
as required. Local counterpart safeguard colleagues and/or translators are to be engaged as
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FSM PPA Stakeholder Engagement Plan
required.
Information Gathering: Quantitative and qualitative information will be acquired detailing thespecific project needs, best practices, lessons learnt, potential synergies with past and current
projects and can be gathered either in written form (i.e. questionnaire surveys) or in face toface interactions (meetings, focus group discussions) with stakeholders. When dealing withinformation elicited from community representatives, the use of culturally appropriatetechniques such as focus group discussions; women’s gatherings, church groups andcommunity associations etc., delivered in local language to ensure that information is collected
separately from different segments of community (elders, youth, women etc.) as appropriate
for the local traditional and cultural systems.
Awareness Raising Techniques: Awareness, particularly of communities, about theforthcoming implementation process and project/s can be raised using oral and culturally
appropriate techniques in local language/s (including information boards) as appropriate toensure community understanding.
Two-way Knowledge and Information Exchange: To be applied throughout the Project cyclewith all key stakeholder and potentially affected or involved communities.
Particular attention will be towards identification and engagement with the vulnerable
groups. Additional support or resources that may be required to enable vulnerable people toparticipate in the consultation process will be identified on a specific case by case basis,
which may include choosing accessible venues for events, providing transportation, choosing
appropriate time of the day, having small, focused meetings where vulnerable stakeholders
are more comfortable asking questions or raising concerns.
Different approaches will generally be adopted for each of the two scenarios identified above:
Scenario 1:
A Project-specific SEP will be prepared for each project under the PPA that will
cover approaches to both Preparation Phase and Implementation Phase consultations.
Scenario 2:
Consultation will be one on one interviews and meetings as required (thescope of consultation will be included in the TOR and the details confirmed in the consultants
work program).

5.3

Timelines
For broader consultation around a Project prepared under the PPA, it is anticipated thatstakeholder engagement will be undertaken during the early stages of PPA preparation.
However, it will not be until the specific PPA initiative’s procurement plan is finalized which
includes the information to develop a detailed activity timeline.
Consultation/s to inform a specific scope of work paid for by the PPA can take place at any
time, independent of project timelines. In these circumstances consideration should be givenby parties undertaking consultation to ensure stakeholder are given sufficient time to prepare
for consultation, particularly if the topic is a specialist area and be flexible in time and delivery.

5.4

Covid-19-related constraints
If Covid-19-related restrictions are in place as set by the FSM Government, the activities under the
PPA will follow the requirements of the FSM government in terms of physical distancing, wearingof personal protective equipment, nature and scale of public and private gatherings and othermeasures as per the Covid-19 response protocols of FSM. Consultations may continue with theuse of phone, email, voice or video conferencing, social media and other measures that would
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FSM PPA Stakeholder Engagement Plan

achieve the goals of physical distancing.
5.5

Review of Comments
For broader consultation around a Project being prepared under the PPA, results ofconsultation will be incorporated in safeguards instruments as required. Concerns voiced by
the stakeholders and commitments consequently made by the project will be recorded in
the SEP Commitment Registrar (Annex A).
For consultation relating to a specific scope of work paid for by the PPA, results will be part of
the annexures of the deliverable.

6

IMPLEMENTATION OF SEP

6.1

Roles and Responsibilities

Type of Stakeholder Consultation
Scenario 1: Consultation on a
specific project preparation funded
under the PPA.
Scenario 2: Consultation to inform a
specific scope of works funded by
the PPA (e.g. policy review, genderstudy, concept design ofinfrastructure etc).

6.2

Roles and Responsibilities
Managed and led by the CIU Safeguard Team (or the E&S
consultant as part of the environmental and social assessment)
and be undertaken in conjunction with the preparation of theenvironmental and social risk management instruments.
In most cases led by the external contracted consultant/s underthe broader management and oversight of the CIU Safeguard
Team. The exact arrangement of duties will be developed on a
project activity basis and delivered to ensure maximum
awareness and understanding.

Grievance Mechanism (GM)
A formal PPA related Grievance Mechanism (GM) has been developed to take into accountculturally appropriate ways of managing community concerns/issues. Processes for
documenting complaints and concerns have been specified, including time commitments toresolve issues. The Grievance protocol is set out in Annex B of this SEP.
The existence of the grievance mechanism will be communicated to all stakeholder groups
during each planned engagement activity. Special communications will be held with thevulnerable groups identified at each location as required.

6.3

Monitoring and Reporting
CIU Safeguard team will maintain an activity file detailing all public consultation, disclosure
information and grievances collected throughout the PPA preparation process on all projects,
which will be available for the World Bank and public review on request.

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FSM PPA Stakeholder Engagement Plan

7

Date

Annex A. Project Commitment Registrar Template

Contact person details

Concern voiced

Recipient community /group Related Documents & location Further background

Related risks

Commitment by project

Project cost

Follow up action, date & task owner Outcome Signed Off

Comments

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FSM PPA Grievance Mechanism

8

Annex B: Grievance (Complaint) Process for the FSM PPA
Introduction
The PPA allows those that have a complaint or that feel aggrieved by project activities to be able
to communicate their concerns and/or grievances through an appropriate process. The GM set
out below is to be used as part of the PPA and will provide an accessible, rapid, fair and effective
response to concerned stakeholders, especially any vulnerable group who often lack access toformal legal regimes.
This Process is intended to ensure the following:••That the basic rights and interests of every person affected by poor environmental
performance or social management of the project are protected; andThat their concerns arising from the poor performance of the project during the phases ofdesign, construction and operation activities are effectively and timely addressed.

While recognizing that many complaints may be resolved immediately, the Complaints Register
and Grievance Mechanism (GM) set out below encourages mutually acceptable resolution ofissues as they arise. The Complaints Register and GM has been designed to:a) Be a legitimate process that allows for trust to be built between stakeholder groups andassures stakeholders that their concerns will be assessed in a confidential, fair andtransparent manner;b) Allow simple and streamlined access to the Complaints Register and GM for all
stakeholders and provide adequate assistance for those that may have faced barriers in thepast to be able to raise their concerns;c) Provide clear and known procedures for each stage of the GM process, and provides clarity
on the types of outcomes available to individuals and groups;d) Ensure equitable treatment to all concerned and aggrieved individuals and groups througha consistent, formal approach that, is confidential, fair, informed and respectful to acomplaint and/or concern;e) Provide a transparent and confidential approach, by keeping any aggrieved
individual/group informed of the progress of their complaint, the information that wasused when assessing their complaint and information about the mechanisms that will be
used to address it; andf)Enable continuous learning and improvements to the GM. Through continued assessment,
the learning’s may reduce potential complaints and grievances.

Overview
This GM covers the activities that could be funded under the PPA. These activities generally consist of
the following:
•
•
•
•

•

Activities necessary for the identification of the pipeline of Projects;
Conducting reviews, studies, assessments and analyses to identify Project designs;
Activities to identify and establish the implementation and institutional arrangements necessary
for the projects;
Supporting the engagement and consultations to develop project safeguard instruments and with
relevant project stakeholders: including national, state and municipal governments, communityand private sector and traditional leaders associated with the development of scope of works anddesign of the Projects; andAll activities related to the preparation and implementation-readiness of the Projects, including

FSM PPA Grievance Mechanism

but not limited to, travel and the hiring of consultants and experts with qualification, experienceand under terms of reference acceptable to the World Bank to support preparatory activities.
A number of PPA related activities will set the tone and direction for investment and will potentiallyhave direct or indirect impacts on communities and individuals within these communities. To mitigate
the risk of adverse impacts, stakeholder engagement including public awareness and understanding of
the project will need to commence as soon as practicable, which requires involving stakeholders early
on in PPA studies and technical advisory stages, and adopting culturally appropriate and effective
consultation techniques. The principal Environmental and Social risks associated with these activities
relate to Occupational Health and Safety (OH&S); cultural and gender based sensitivity issues
associated with stakeholder interactions; and employment/recruitment risks relating to Labor
management.

Eligibility Criteria for the GMa) Perceived negative economic, social or environmental impact on an individual and/or
group, or concern about the potential to cause an impact;b) Clearly specified kind of impact that has occurred or has the potential to occur andexplanation of how the project caused or may cause such impact; andc) Individual and/or group filing of a complaint and/or grievance is impacted, or at risk ofbeing impacted; or the individual and/or group filing a complaint and/or grievancedemonstrates that it has authority from an individual and or group that have been or may
potentially be impacted on to represent their interest.
Local communities and other interested stakeholders may raise a grievance/complaint at all
times to the traditional and government elected officials. Affected local communities will be
informed of the PPA safeguard instrument provisions, including its grievance mechanism andhow to make a complaint through stakeholder awareness and engagement activities.
During all Stakeholder Engagement Activities, there will be a statement announcing that there isa Grievance Mechanism where Stakeholders can raise complaints and have them processed.
Information will include the provision of names, contact details and locations (physical address,
email, phone numbers and web sites) to where stakeholders can log their complaints. All
information including the GM and associated PPA safeguard instruments will be disclosed on
DOFA and DCT&I official government websites and up loaded to FSM government web pages(e.g. facebook) to ensure access to all.
The project level process (this GM) will not impede affected persons access to the FSM legal
system. At any time, a complainant may take the matter to the appropriate legal (Police) or
judicial authority as per the laws of the FSM. These matters may include illegal drug trafficking,human trafficking, prostitution, child labor, gender based violence and so forth.
Complaint/Grievance Report Form
Complaints may be received in any form, from anyone, including anonymous. Anyone in the team
may receive a complaint at any time. All complaints shall be immediately forwarded to the DTC&I(national government (PIU) and/or Project Manager – once a PM is on board) and/or the DTC&I State
counter part agency (to be developed on a case by case basis) and/or the CIU National Safeguard
Coordinator and/or Program Manager. All such contacts will be recorded and screened to determine
whether the complaint is PPA related and as such needs to be addressed. If the complaint is not PPArelated then it is closed (or referred to the correct agency). All grievances and/or complaints are to berecording using the grievance recording template included below.

FSM PPA Grievance Mechanism

GM Complaints Process
The GM has been designed to be problem-solving mechanism with voluntary good-faith efforts.
The GM is not a substitute for the legal process. The GM will as far as practicable, try to resolve
complaints and/or grievances on terms that are mutually acceptable to all parties. When making
a complaint and/or grievance, all parties must act at all times, in good faith and should not
attempt to delay and/or hinder any mutually acceptable resolution.
The process for the GM is as follows:
Stage
•
A

•

B

•
•

•
•

C

•

•
•

•

•
D

•

•
•

•

1

Grievance Process
Aggrieved Party (AP) takes their grievance to the DTC&I (national government
PIU and/or Project Manager – once a PM is on board) and/or the DTC&I State
counter part agency and/or the CIU National Safeguard Coordinator and/or
Program Manager1.
If the AP takes a grievance-issue to the project consultant/s they are to
immediately notify one of the above to address the issue.
The above, identified agencies/personnel will endeavor to resolve any and allcomplaints – issues immediately.
For complaints that were satisfactorily resolved for the incident the resultant
resolution will be logged and reported to the CIU Program Manager whom will
inform the CIU safeguard team, PIU (i.e. DTC&I), Project Manager if engaged.
Through normal CIU reporting processes the DoFA Assistant Secretary andSecretary will be informed.
All complaints records (letter, email, record of conversation) are to be stored
together (electronically and in hard copy) and housed within the CIU.
Each record is to be allocated a unique number, reflecting year and sequenceof received complaint (i.e. 2020-01, 2020-02 etc.).
For complaints that the Aggrieved Person is not satisfied with the outcome(stage B), the above identified agency/personnel will refer the Aggrieved
Person to the PPA Project Manager (if engaged) or DTC&I PIU (until a PM isengaged) and the Central Implementation Unit - CIU (Program Manager andSafeguard team).
The complaint/issue is to be resolved by the PPA Project Manager (if notengaged DTC&I (PIU) and/or CIU team) and inform the Aggrieved Party.
For complaints that were satisfactorily resolved for the incident the resultant
resolution will be logged and reported to the CIU Program Manager whom will
inform the CIU safeguard team, PIU (i.e. DTC&I), Project Manager if engaged.
Through normal CIU reporting processes the DoFA Assistant Secretary andSecretary will be informed.
All complaints records (letter, email, record of conversation) are to be stored
together (electronically and in hard copy) and housed within the CIU.
Each record is to be allocated a unique number, reflecting year and sequenceof received complaint (i.e. 2020-01, 2020-02 etc.).
For complaints that the Aggrieved Person is not satisfied with the outcome(stage C), the complaint/issue will be referred to the DTC&I and/or DoFA
Secretary (depending on the content of the complaint).
The complaint/issue is to be resolved by the Secretary (DTC&I and/or DoFA)
and inform the Aggrieved Party.
For complaints that were satisfactorily resolved for the incident the resultant
resolution will be logged and reported to the CIU Program Manager whom will
inform the CIU safeguard team, PIU (i.e. DTC&I), Project Manager if engaged.
All complaints records (letter, email, record of conversation) are to be stored
together (electronically and in hard copy) and housed within the CIU.

Duration
Anytime &immediately
grievance isrecorded.

Immediately
Resolution within
one week.

Loggedimmediately once
notified.

Resolution within
two weeks.

Loggedimmediately once
notified.

Resolution within
one month.

All PPA related consultant/s field activities will be accompanied by a staff member from the national and state representative of DTC&I and CIU
safeguard team as such all grievances will be able to be received and address on site as the first management level.

FSM PPA Grievance Mechanism

Stage
•

E

•

Grievance Process

Duration

Each record is to be allocated a unique number, reflecting year and sequenceof received complaint (i.e. 2020-01, 2020-02 etc.).
For complaints that the Aggrieved Person is not satisfied with the outcome(stage D) proposed by the Secretary (DTC&I and/or DoFA), the Aggrieved
Person may refer the matter to the appropriate legal or judicial authority. The
decision of the court will be final.

Anytime based on
legal time lines.

How to Get in Touch
Anyone can make a complaint, raise a grievance, ask for information on the project or get in touch for
any reason. Complaints can be anonymous. The various ways to get in touch are:Department of Finance and Administration Department of Transport, Communications and(DOFA) & Central Implementation Unit (CIU)
Infrastructure. (DTC&I)
In Person:
Division of Investment and International Finances
Department of Finance & Administration (DOFA)FSM National Government, Palikir, Pohnpei FSM

Project Management Unit (PMU)
Department of Transportation, Communication &Infrastructure (DTC&I)
FSM National Government, Palikir, Pohnpei FSM

By Phone:
CIU Office, DOFA Palikir (691) 320-2639/2640
CIU National Safeguard Coordinator (Mr. Wilmer
Kilmete).
CIU Program Manager (Mrs. Beulah Daunakamakama)
DoFA Secretary (Mr. Eugene Amor)PMU Office, DTC&I Palikir: (691) 320-2080/2865/2381
PMU Program Manager (Mr. Robert Goodwin)
Assistant Secretary for Infrastructure (Mr. Dickson
Wichep)DTC&I Secretary (Mr. Carlson Apis)

Web Site:
CIU Office, DOFA Palikir(https://dofa.gov.fm/grievance-redress-mechanism/)

PMU Office, DTC&I Palikir
https://www.tci.gov.fm/contact.html

By Email:
Mr Wilmer Kilmete: wilmer.kilmete@dofa.gov.fm
Mr. Robert Goodwin: rscgoodwin@hotmail.com
Mrs. Beulah Daunakamakama: Beulah.fsm@gmail.com Mr. Dickson Wichep: wichep66@gmail.com
Mr. Eugene Amor: eamor@sboc.fm
Mr. Carlson Apis: carl@tci.gov.fm
By Mail:Central Implementation Unit
Project Management Unit Office
Division of Investment & International Finance
Department of Transportation, Communication &P.O. Box PS-158
Infrastructure
Palikir, Pohnpei FSM 96941
P.O. Box PS-2
Palikir, Pohnpei FSM 96941

This information, and a brief summary of the process for answering queries and managing grievances,
will be published on the DoFA, DCT&I and CIU government websites.

FSM PPA Grievance Mechanism

Grievance Report Form
Grievance Information: Summaries Details
Name of Complainant (oranonymous), and gender

Employee ID (If
Employee)

Telephone

Email

Date of Complaint

Date of 1 week deadline
for resolution or
escalation:

Actual date of close out:

Date, time, and location of Event leading to Grievance:

Detailed account of Grievance (Include names of persons involved) if known:

Are there any policies, procedures, guidelines that may have been violated:

Proposed solution or sought remedy:

Outcome of Grievance:

FSM PPA Grievance Mechanism

Date and Signature of Entry into Record:

Date and Signature of Close-out: