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Grievance Procedures: Model Form & Best Practice


Washington Administrative Code (WAC) 388-61A-0160 requires that domestic violence emergency shelter programs funded by DSHS have a written grievance policy and procedure for program participants.

Running a program and providing services that meet the needs of survivors and their children is important and challenging work. Hearing about the experiences of survivors in your program can be extremely valuable in guiding and informing your work. Having a clear and understandable grievance policy underscores the importance of hearing from program participants who have concerns. It is a way for programs to learn about their challenges and come up with ways to improve services.

While this form is specifically for grievances, programs may also want to consider other ways of engaging participants in providing feedback, such as former resident councils, exit evaluations, or survivor networks.

Best practices and how this form may impact your rules, policies, and procedures


Program participants should be notified that you have a grievance procedure upon intake and again if repeated efforts to resolve problems are unsuccessful.

How and when to give the form to program participants

This form represents the final piece of the puzzle, not how the conversation begins. Filing a formal grievance should only happen after all other efforts to address the problem have been attempted.

Programs may choose to give the grievance form along with a stamped and addressed envelope to provide the program participant with assurance that the grievance will be submitted to the appropriate personnel.

Staff structure

Programs need to tailor the form to address their particular hierarchy and staff structure so that the chain of command is clear and easy to follow.


Each program needs to figure out an appropriate deadline for when and if participants will get a response about their grievance. The process should be clear and the agency must ensure that it follows its policy and procedures, should a grievance be filed.


Programs should do their best to ensure that this grievance process is accessible to those who are unable to fill out this form.

For participants who are physically unable to sign, there are ways to help people tell their story and give their permission. For ideas on how to do this, check out the appendix of the Model Protocol on Screening Practices for Domestic Violence Victims with Disabilities.

If the participant is non-English or limited-English speaking, it is important to have this form translated.