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BARRIER FREE LIVING, INC.
270 East Second Street
New York, NY 10009-7815
DOCUMENTATION OF GRIEVANCES
NAME: _________________________________________________________________________
Nature of Complaint:_______________________________________________________________
________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Signature ____________________________________________________Date________________
Disposition Date: ___________________________________
Description of the Disposition:
Worker Signature Supervisor Signature
Disposition: 9 Satisfactory 9 Unsatisfactory
Comments:
Consumer Signature ______________________________________________________________
Administrative Review: _________________________________________Date:_______________
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