Pitts v. Sequeira et al
Filing
176
ORDER GRANTING IN PART AND DENYING IN PART DEFENDANTS' MOTION FOR SUMMARY JUDGMENT; EXHIBIT A. Signed by JUDGE LESLIE E. KOBAYASHI on 1/14/2014. Re: 112 Amended Motion for Summary Judgment. (Attachments: # 1 Ex hibit A) (1) Defendants' Motion for Summary Judgment is GRANTED as to Pitts' claims that Defendants'Rivera, Tanuvasa, and Hernandez failed to protect him from assault or retaliated against him in violation of federal or s tate law. (2) Summary judgment is DENIED as to Pitts' claims against Dr. Leland. (ecs, )CERTIFICATE OF SERVICEParticipants registered to receive electronic notifications received this document electronica lly at the e-mail address listed on the Notice of Electronic Filing (NEF). Participant Joseph C. Pitts who is not registered to receive electronic notifications wasserved by first class mail on the date of this docket entry Modified on 1/15/2014 (ecs, ).
DEPARTMENT
OF PUBLIC SAFETY
CHAPTER NO. :
12
INMATE GRIEVANCE AND APPEALS PROCESS
1 .0
SUPERSEDES NO. :
493.12.03
DATE: 01 /04/90
Page
PURPOSE
To establish standard procedures for governing an inmate grievance system
which will achieve the following objectives:
.1
.2
Improve institutional management, control, and conditions by
establishing a mechanism which will identify institutional problems
and afford a means for corrective action .
.3
Reduce inmate litigation by establishing a system which will
encourage its full utilization to resolve valid and justified
grievances before resorting to the Courts .
.4
2.0
Reduce inmate frustration and the need to resort to unacceptable
behavior by providing an effective and credible mechanism for
inmates to voice a grievance and receive a prompt, meaningful
response from administration .
Promote a more credible and effective inmate grievance system and
improve staff/Inmate relationships and communication by establishing
a mechanism which will promote inmate involvement and commitment to
the grievance process.
REFERENCES AND DEFINITIONS
.1
References
a.
b.
Departmental Policy and Procedures Manual, 493. 12.02, Inmate
Access to Courts, Legal Services, and Legal Materials:
493. 12.04, Access to Ombudsman.
c.
.2
The Civil Rights of Institutionalized Persons Act, 42 U.S.C.
Sec. 1997. Standards for Inmate Grievance Procedure 28CFR
§40. 3.1.
Administrative Rules of Department of Public Safety,
Sub-chapter 5, Administrative Remedy of Complaints .
Pefin1tions
a.
Inmate Gr1eyance Soecia11st - Person designated to track,
process, and assign Complaints/Grievances to the designated
person for response/resolution.
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b.
c.
Grievance - A grievance 1s an injustice or unfair treatment an
inmate/ward believes has been inflicted as a result of
inconsistent, coercive, or disciplinary application of a policy
or rule by correctional personnel or the Adjustment or Program
Committee.
d.
Appeal - An appeal is a process whereby an inmate initiates
further action within limits defined herein if dissatisfied
with the disposition of the complaint/grievance,· disciplinary
action, or classification action.
e.
Hearing - A hearing is a scheduled meeting wherein information,
relevant evidence, or witnesses' testimony may be presented to
assist in the adjudication of a complaint/grievance,
disciplinary action appeal, or classification action appeal.
f.
(
Complaint- A complaint is a specific allegation of wrongdoing,
allegedly to have occurred within a facility against another
person or persons.
Inmate - Any person confined within an institution of the
department who is either sentenced, pre-sentenced, or pre- trial.
g.
Informal Discussion/Resolution -Action taKen or discussion
held to solve a problem or relieve a situation without formal
process, to reach a result acceptable to all parties.
h.
Department Inmate Grievance Officer - Person designated by the
Director to administer the department grievance system.
i.
Institutional Policy or Practice- Any policy or practice which
has general applicability to the inmate population.
'
I
3.0 POLICY
.1
Every inmate under the jurisdiction of the Hawaii Correctional
System shall be provided an opportunity to submit written grievances
to a designated official. A prompt resolution of an inmate
grievance, supported by well considered reasons. is essential in
order to ensure the rights of the inmate and to ease any sense of
frustration and ill-treatment .
.2
All inmates shall be entitled to invoke the grievance procedure
regardless of any disciplinary, classification, or other
administrative or legislative decision to which the inmate may be
subject. Grievance procedures shall also be accessible to those
inmates who are impaired or handicapped.
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Inmates shall not be punished, disciplined, or denied any privileges
when they invoke the grievance or appeal process .
.4
Staff members shall not refuse to process a grievance on the grounds
of invalidity or triviality .
.5
Inmate and staff shall be provided a role in the grievance process.
Inmate and staff opinion shall be solicited for grievances
challenging institutional policies and practices.
4.0 ADMINISTRATION OF SYSTEM
.1
Each facility Inmate Grievance Specialist shall be assigned by the
Department Inmate Grievance Officer. The responsibility of the
position shall be, but is not limited to, the following:
a.
b.
(
Insure that all grievances are recorded on the computer and
tracked through each step of the grievance process.
Screen all inmate grievances. This screening shall take place
prior to submittal to the first level of resolution, and shall
decide what action should be taken to expedite the grievance.
1)
Assign the grievance for investigation and response to the
designated person.
2)
Forward emergency grievances to the Facility Administrator
for immediate response.
3)
Determine if the grievance requires inmate and staff
participation.
4)
Post synopses of grievance requiring inmate/staff
participation and solicit opinions .
5)
Ensure that all grievances and appeals are being responded
to within the specified time limits.
6)
Periodically evaluate and report on the perfor.mance of the
facility grievance system. and provide documented
specifics.
7)
Ensure the integrity of the facility grievance system.
8)
Investigate grievances or perform other duties as assigned.
9)
Submit monthly report to Department Inmate Grievance
Officer.
.
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Controls Over the Position
This position receives general and technical supervision from the
Department Inmate Grievance Officer, it receives direction from the
Facility Administrator on.matters relating to security, facility
operations, and policies· and procedures .
.2
The Department Inmate Grievance Officer shall be responsible for:
a.
Monitoring all facilities for compliance with departmental
grievance procedures.
b.
Ensure that all grievances and appeals are being responded to
within the specified time limits.
c.
Annually develop an evaluation report concerning the
performance of the grievance system at all facilities.
d.
Training of staff in all matters relating to the grievance
procedure.
e.
Report to the Director, on a monthly basis, the health and
effectiveness of the grievance process.
(
.3
INMATE AND STAFF PARTICIPATION IN RESOLUTION OF GRIEVANCE
Inmates and employees are provided a role in the operation of the
grievance system at each institution. Each facility shall be given
the flexibility to choose from two (2) systems of participation.
The Inmate Grievance Specialist is required to solicit opinions from
inmates and staff on grievance~ challenging general policy and
practices. If a grievance challenges an institution policy or
practice and the inmate objects to the participation of other
inmates and institutional staff in the resolution of the grievance,
the inmate may indicate such objections on the grievance form.
Inmates are not allowed to participate in the resolution of any
other inmates grievance over the objection of the grievant. One or
both of the following systems may be used after it has been
determined that inmate and staff participation shall be. solicited.
Option 1
a.
A synopsis of the grievance, without the name of the inmate,
shall be posted in each housing unit and other prominent areas
that are accessible to inmates and staff. Staff and inmates
shall be asked to submit their opinions in writing, to the
Inmate Grievance Specialist within five (5) calendar days. The
Inmate Grievance Specialist shall compile the results and based
upon his/her judgement, recommend one (1) of the following:
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1)
no change to the existing policy;
2)
delete the policy or practice;
3)
change or modi.fy. the policy or practice.
This recommendation may be challenged on appeal by the grievant.
Option 2
b.
A synopsis of the grievance, without the name of the inmate,
shall be posted in each housing unit and other prominent places
that are accessible to inmates and staff. Using
Complaint/Grievance Form No. 8250, the Inmate Grievance
Specialist shall randomly select three (3) inmates and three
(3) staff to solicit their opinions. The Inmate Grievance
Specialist shall compile the results, and based upon his/her
judgment, shall make one of the following recommendations:
1)
2)
delete the policy or practice;
3)
(
no change to existing policy or practice;
change or modify the policy or practice.
This recommendation may be challenged on appeal by the grievant.
c.
d.
.4
In all instances, the function of inmate and staff
participation in the resolution of grievances shall be to help
solve problems - not to judge guilt.
Inmate and staff participation may take place at any level in
the grievance process but at minimum must take place at the
first level. Before a final decision in resolving a grievance
is reached at any level, the advice of staff and inmates shall
be considered. The final decision shall still rest with the
designated staff reviewer .
LQG SYSTEM FOR INMATE CQMPLAINT/GRIEVANCE
a.
The Inmate Grievance Specialist shall keep a computer log of
Inmate Complaint/Grievances and submit a copy of the completed
log to the State Inmate Grievance Officer and to the Facility
Administrator upon request.
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All grievance records shall be maintained, at the facility
where the inmate is housed, for a minimum of three (3) years
after the final response is issued to the grievant. If an
inmate is transferred their grievance records will be forwarded
to the Inmate Grievance Specialist at the receiving facility.
At a minimum, the records for each grievant shall contain:
1)
initial Grievance and Response
Medical Services
al. General services
a2. Dentist
a3. Slow or no treatment
a4. Other - specify
b)
Complaints against staff
bl.
b2.
b3.
b4.
bS.
ACOs - Security
Counselors
Unit Managers
Section Supervisors
Other Staff - specify
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Facility Operations
cl. Food
c2. Clothing
c3. Sanitation
c4. Personal property
cS. Library
c6. Other - specify
d)
Disciplinary Matters
dl.
d2.
d3.
d4.
e)
Lockdown
Segregation
Adjustment Committee
Loss of Privileges
Community Communications
el. Ma11
e2. Telephone use
e3. Vis its
e4. Other - spec1 fy
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Community Programs
fl.
f2.
f3.
g)
Program Assignments
gl.
g2.
g3.
g4.
h)
Furloughs
Community treatment
Other - spec1 fy
Custody
Worklines - general
Horklines - education
Other - specify
Urinalysis
hl. Improperly done
h2. Violated rights
h3. Other - specify
j)
Transfers
jl. Hit hi n fac111ty
j2. Between fac111t1es
j3. Mainland
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Phys1cal Facility
Maintenance
k2. Construction
k3. Store· .
k4. Laundry
kS. Other - spec1fy
kl.
1)
Legal
11 . Jail time
12. Detainers
13. Sentence computation
14. Other - specify
m)
Other - Specify
n)
Business Office
nl.
n2.
n3.
n4.
ns.
(
p)
Deposits
Store Accounts
Workline pay
Money transfers
Other - specify
Policy and Procedures
pl. Security
p2. Housing
p3. Programming
p4. Other - specify
.5
CQDfideotiilit~lCQotrg]]ed
A''iSS
Access to records and files of complaints/grievances shall be on a
need to know basis as determined by the Inmate Grievance
Specialist. Records and files regarding the participation of an
individual in grievance proceedings shall not be available to other
inmates or to individuals participating in parole decistons .
.6
Eyaluatjgn
Monthly, Formative Statistical evaluations, using department MIS
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Filed
Open
Closed
Step 1
Step 2
Step 3
Upheld
Other
Information Discussion/Resolution
Days Receipt to Disposition
Inmates Filing First Time
Posted for Opinions
Grievance Specialists will submit, a monthly narrative report or
their Facilities grievance process which will include the above
statistics.
Review
Annually, in July, each facility will review its grievance
procedures. One (1) wee~ prior to this review a questionnaire will
be posted to solicit staff and inmate opinions of the grievance
process. At a minimum, such a review w111 examine inmate use of the
grievance procedure and whether such use has resulted in meaningful
consideration of complaints/grievances, and where appropriate,
adequate remedies for grievances. Such evaluation/reviews will be
submitted to the Director of Public Safety, State Attorney General,
and the State Legislature.
(
.7
Communication of Procedures
a.
An oral explanation of the grievance procedure is to be given
to each inmate and employee upon arrival at an institution.
Inmate Grievance Specialist is assigned the responsibility of
training inmates and staff on the grievance procedure
(493.12.03).
b.
The Inmate Grievance Specialist is responsible to ensure that
provisions are made for non-Eng11sh spea~ing inmates, as well
as for impaired or handicapped 1nmates. The written procedures
shall be available tn a language other than English if tt is
found that a significant part of the population of an
institution spea~s that language.
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Staff assistance shall be available for those inmates who
cannot prepare their grievances un- aided .
Remedies
The grievance procedure .s.ha 11 afford a grievant a meaningful and
just remedy.
a.
All grievances shall be considered in view of the following in
developing a remedy.
1)
Has the inmate made a claim that implicates a right
guaranteed by either the State or Federal Constitution or
a State or Federal Statute or Regulation.
2)
Has such a right in fact been violated or abridged.
3)
Can the abridgement of the right be justified by a
legitimate institutional interest in order, security, or
rehabilitation.
4)
Are there ways of protecting those legitimate interests
ladequately while minimizing the abridgement of the
claimed right.
(
b.
Legal opinions and advice may be obtained from the Attorney
General. Consult procedures outlined in DOC Policy, 493.01.19
(Legal Opinions and Memorandums, Request Forms>.
c.
A standard range of meaningful remedies shall be employed,
although available remedies may vary among institutions. All
staff responsible for answering a grievance shall use the
following guidelines, as a minimum, in developing a response.
1)
Grievances which question the 1nterpretat1on of a policy
or procedure:
Site authoritative opinions and interpretations, whenever
possible, such as opinions of the Attorney General or a
basis in State or Federal law. Explain what action will
be taken, if necessary, to further clarify the meaning or
intent of the policy or procedure. As an example, explain
that policies will be revised or recommendations made for
revision to clarify their intent. If recommendations to
administration will be made for revising policies, explain
what those recommendations will be.
1992
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of
Grievances which question the application of a policy or
procedure:
Explain what direction or instructions will be given to
relevant employee or employees to ensure they will
correctly apply the policy or procedure.
3)
Grievances concerning an action of an employee or reprisal:
If the grievance is valid, so notify the inmate and
explain that disciplinary action will be taken against the
employee. The type of action taken shall not be
communicated to the inmate.
4)
Grievances concerning an action of another inmate:
Explain what measures will be taken to protect the
grievant, such as reassignment of housing of one or both
parties. Also explain what action will be taken to
protect the grievant against reprisals.
5)
(
Grievances concerning classification or programming:
Specify what action will be taken such as transfer,
reduction of custody level, award of furlough, change of
work assignment, etc.
6)
Grievances concerning time computation:
Explain there will be prompt re-computation with expedited
processing of any privileges or improvement in status
which may have been lost as a result of any error in
computation.
7)
Grievances concerning loss of property under the custody
and control of the facility:
Specific prompt action will be taken such as return of
property, replacement of property of equal value at time
of loss, or monetary payment equal to value of property at
time of loss, and so forth.
8)
Grievances concerning living and working conditions:
Specify what steps will be taken to immediately improve
conditions. If conditions cannot be immediately improved,
explain the reason and what action will be taken.
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d.
No coercion, discrimination, reprisal, or any adverse action
shall be imposed upon inmates for filing a grievance or appeal,
or upon staff members and inmates participating in the
resolution of grievances. To further promote this policy, the
following practices. sball be followed:
1)
All inmate grievances shall be kept confidential
should make a good faith effort to informally resolve a
Complaint/Grievance. The committed person having reached a
decision to file a formal grievance shall do the following:
a.
Obtain Complaint/Grievance Form 8215 from any staff member
(forms are readily available). If the form is not on hand,
staff will supply the committed person with a
Complaint/Grievance Form as soon as possible.
b.
Committed person must fill out the form completely; 1.e .• name,
SID number, date, housing unit, etc. Staff or inmate
assistance may be utilized for committed persons who cannot
prepare their complaint/grievance un-aided.
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c.
Take the completed Complaint/Grievance Form 8215 to the housing
duty officer who will:
1)
Check to see if the form is complete with name, SID
number, date, ~ignature, housing unit, etc.
2)
If the form is complete, the officer will sign and date
the Complaint/Grievance Form 8215 in the upper right-hand
corner.
3)
Staff will not alter the form or refuse to accept same.
4)
The committed person will be given the designated "inmate
receipt" copy for his/her records.
d.
e.
(
The inmate will immediately .
The Facility Administrator has fifteen (15) working days from
the day of receipt of the appeal in which to subm~t a written
response to the inmate. Should the 15 working days elapse
without the inmate receiving a written response, an appeal
directly to the appropriate Division Administrator may be
initiated.
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f.
Upon receipt of the Facility Administrator's written decision
the inmate has up to five (5) calendar days to initiate further
action If dissatisfied with the decision made by the Facility
Administrator.
g.
Appealing the Facility Administrator's decision.
1)
The inmate shall appeal to the Division Administrator.
2)
The inmate shall subm1t a written statement on
Complaint/Grievance Form 8215 regarding the basts for the
appeal to the Division Administrator via mailbox or other
designated repository.
3)
The Inmate Grievance Specialist shalt forward copies of
the following information to the Division Administrator:
a)
inmate's original comptatnt/grtevance;
b)
the decision of the Unit
Administrator;
(
C)
the appeal statement to the Facility Administrator;
\
d)
decision of the Facility Administrator.
Manag~r
or Section
4)
The Division Administrator shall give the inmate a signed,
dated acknowledgement of receipt of the appeal.
5)
The Division Administrator may:
a)
b)
6)
request additional information from the facility;
conduct an investigation or hearing.
The Division Administrator has twenty (20) working days
from the receipt of the appeal in which to submit a
written response to the inmate •
. 16 The decision of the Division Administrator shall be final.
a.
Appeal to the Division Administrator shall be the ultimate
recourse available to inmates within the administrative remedy
process.
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. 17 Powers of the Administrative Reviewer(s)
a.
Sustain, modify, or overturn the decision of the lower decision
·
maker(s).
b.
The Administrative Reviewer shall also justify and explain all
decisions in the written response to the inmate.
c.
The period of time for action by the reviewing offic1al(s) may
be extended up to fifteen (15) working days upon a finding that
the circumstances are such that the initial period is
insufficient to make an appropriate decision. The time
extension must be agreed to by the inmate in writing .
..
. 18 Procedure for appealing disciplinary decisions.
a.
(
Disciplinary measures imposed by an Adjustment Committee in
accordance with the provisions of the Administrative Rules of
the Department of Corrections 17- 201-19 shall normally commence
forthwith. The Facility Administrator, however, shall have the
authority to hold such disciplinary measures in abeyance
pending the inmate•s appeal if the administrator believes such
action to be in the best interest of the inmate and/or facility.
1)
The inmate who wishes to request a delay in the imposition
of disciplinary measures shall, in a letter, justify to
the Facility Administrator the reason(s) why a delay is
necessary. The Facility Administrator shall respond to
the inmate in writing within three (3) working days.
2)
The Facility Administrator's denial of the inmate•s
request to have the sanction held in abeyance 1s
grievable. The imposition of the sanction will not be
delayed, however, pending the disposition of the request.
3)
Grievances of this nature shall be processed as a
privileged complaint and shall be forwarded immediately to
the Division Administrator. The Division Administrator
shall respond w1th1n five (5) working days from the day of
receipt of the grievance.
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4)
Any loss of privileges and segregation time sustained by
an inmate during the pendency of the appeal shall be
credited to the inmate and deducted from the original
disciplinary measures Imposed by the Adjustment
Team/Comm1ttee .1n the event the Administrative Reviewer(s)
rules against the fnmate•s appeal.
b.
All Inmates have the right to seek administrative review of any
disciplinary action through the administrative remedy process.
Review shall be initiated within fourteen (14) calendar days of
the day of receipt of the disciplinary decision.
c.
The steps for appealing disciplinary actions:
1)
2)
Decision of Unit Adjustment Team:
3)
(
On- the- spot correction: Section Administrator or Unit
Manager - Facility Administrator
Decision of Facility Adjustment Committee:
Administrator - Division Administrator
Facility Administrator
Facility
d.
The inmate appealing the disciplinary action(s) imposed shall
file an appeal on Complaint/Grievance Form 8215.
e.
Each Administrative RevlewerCs> shall:
1)
Receive the complete file of the case, Including, but not
limited to:
a>
the incident report;
b)
the investigation report;
c)
record of the hearing.
2)
Evaluate all the written documents submitted.
3)
Conduct an Investigation to obtain further information
when the record does not clearly establish:
a)
the evidence upon which the disciplinary group has
based its decision;
Case 1:11-cv- QLLt:;Q_J~K~KSC
~~~v~' ·
INMATE GRIEVANCE AND APPEALS PROCESS
PSO
P &PM
i
Document 146-3 Filed 10/18/12 Pag·e 24_Qf. ?9 ,_ pageiD
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t.
"'APRc. :_ 3 1992
23
~f
\
b)
4)
the reason(s) for imposing such disciplinary
measure(s).
Determine whether the decision of the disciplinary group
was based upon substantial and adequate evidence and
whether the disciplinary measures are excessive.
f.
The administrative reviewer shall submit a written and
signed response to the inmate within fifteen (15) working days
of the receipt of the appeal. Should the fifteen (15) working
days elapse without the inmate receiving a written response, an
appeal directly to the Division Administrator may be initiated.
g.
Upon receipt of the reviewer's decision, the inmate has up to
five (5) calendar days to initiate further action if
dissatisfied with the decision.
·
h.
If the inmate initiates further action, a statement regarding
the basis for the current appeal is required.
i.
The facility shall submit to the reviewer the complete case
record of the case on appeal.
j.
Upon receiving an unsatisfactory response from the Facility
Administrator, the inmate 1s free to initiate further appeal
actions.
k.
Reviewing officials may extend for up to fifteen (15) working
days if it is determined that the initial period is
insufficient to make an appropriate decision. The grievant
must agree in writing to any extension.
1.
The decision of the Division Administrator ts final .
/
(
. 19
Procedure for Appea11ng Un1t Team or Program CorrmHtee:
24
Case 1:11-cv-00459-LEK-KSC Document 146 6 Filed lQ/18/12 Page 25 of 29
! S~BJ~C~:
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INMATE GRIEVANCE AND APPEALS PROCESS
PSD
P &PM
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EFFEC-:"; IE :~-;-:::
APR -3 1992
i Page
1>
c.
24
-:::~
Program Committee's decision- Facility Admlnl1tratorDivision Administrator
The process for ·~ppeal of Program Committee decisions Is the
same as the process for appeal of disciplinary actions .
·.20 -Referral to Agencies or Officials other than Departmental
a.
b.
5.0
An Inmate should, but Is not strictly required to, first
exhaust the administrative process set forth In this gollcy for
the resolution of complaint/grievance before seeking aid from
the Ombudsman or other agencies or filing suits In court.
Inmates are advised that courts frequently requlrt evidence
that administrative remedies have been exhausted before
accepting jurisdiction over a complaint/grievance.
Scope:
This policy applies to all Department of Public Saf.ety facilities.
(
APPROVED:
~ ..
o;rector
Lf -3-1-...
Date
(doc OSSOsl
-
-
2 .;
Case 1:11-cv-00459-LEK-KSC
~i
2
Document
1!4~3i Fil~dA.:P@tl~/Ys
Page
[NMATE citMP@.l-lNT/GiHOANC£
J•JOJL
2~\ltjcf':
~~
r;>·ageiD
!•
T INC: - - - - - - OAT[; - - - - - - -
I
(THIS ,.,, I'IVST ACCOM'ANY
ALl. APtll.lU I
lAAE: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ SICt
-----------------
HOUS[NG liSS[GNMENT: - - - - - - - - - - - CONTROL NO.:
TO:
(STEP)
l.
z. -
3.
-
&rievance Spectaltst
Facility A~1ft1strator
Dtviston Adainistrator
attempted to solve this problem through informal
-----------------
d1seusslon/~t·ol"t~on by
•
..
1
eontactinq:
NAME: - - - - - - - - - - - - - - - OATE: _ _ _ _ _ _ _ _ _ __
RESPONSE: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
RE:
Complaint/Gri evance Against= - - - - - - - - - - - - - - - - - - - - --
STATEMENT OF COMPI.AINT/GRIEVANCE:
(
~~MPLAlHT/GRIEVAHf.E
lttuc" •aalttaftel ai\Mu ••
~------
fttti .
! ICAXfO Or NtsrbAbtAf
Nt
~
"-•••••ry)
WOULD BE SOLVED TO MY SATISFACTION IF:
-----
.,.....
_ _ __
6Xit
bAli
Xe&llttDW
WM ITI/ flt t
CAHAI'fII MIU ,,.,..,
A'l"J:!AC:IMINT l
:Je:c:s:~ N#:
::>r::? 3
A?!?EA1
5
OtV!SION
A N.
CMI
( C,UnDAI )
DA'iS
78
IN
WRITING
OlVEST !-
GA'!'tON
20
l S 04YS -----~
WOl:U.t
Case 1:11-cv-00459-LEK-KSC ... Q~~'z!qy(~'h1~ 6-:f :/!~!A/_18/12 Page 28 of 29
VI
.!) • - - .:14! e•l
~EC~RD o!' :Nro~ ' ttrscussroN a!' GRI~IANC~
.
-._-.:"J!:. m •
PageiD
I
:-:eld ·o~ · __
If ~arties are unable to re~ol~! ::~o· ~~~
a .qr1evance ( form 8215 ) is fl.led, a copy ot this form will be u- 4 ,.:.=~-··-
This form is to be comple ted wheneve r: an informal discussi n .
inma~a raqardinq a qr1evanc•:
DOC 8215.
(
- ....... ::
!
1·
\
Grl.evant
?Oil.l:l.On
Oaee of discussion: _ _ _ _ _1'ime: _ _ _ _ Plac
I~CIVICUALS
PRESENT AT DISCUSSION:
NAMES:
Alleqed Violation
Other I I
Date ot
time ot
2. What il
1.
(
o~
~odule
ot discussion: _ _ _ __
POSITIONS:
Kandbook I I HRS I I Adminiatrative Procedure• 1 1
------------------------------------------------------
alleqed viol&tiona (date ( l )a day/ month/year/, shift, it applicab.
day·--------------------------------------------------------the qrievanee speci~ieally (circumstance• aurroundinq 9rievanca 1?
J.
What remedy does the qrievant seek? ___________________________________
4.
Who are the
~eraona
iAVolved in the qrievance (namea and claaaitieations l ?
s. Where did the incidaac
o~
actioft t&ke'place? ___________________________
6.
What adviee waa qiVID o~ action taken by the immediate supervi1o:
(<ernat1vea fo~ potai~l• reaolution• no :eaolution polti~le l? ______..._._
7 ·.
waa the advic:e qiven o&- action talciA by the immediate aupeniacr
to the
_________________________________________
.
satiafac~ory
q~ievaftt?
Siqnatu:e of G~iiV&At.'
J
Slqnature o! Supervtaor
(Attac:h Pt~tinent cocumentl if Applic:abll )
I_t aclditJ.on&l t;ta.c.e.-ne.aecl u11 ~•c)C o~ p~• •
Case 1:11-cv-00459-LEK-KSC Document 146-3 Filed 10/18/12 Page 29 of 29
#: 784
PageiD
STATE OF HAWAII
Department of Public Safety
~OT!CE
FOR:
~
(
FACILIT~
OF
G~!EVANCE
Facility
GRIEVANCE SPECIALIST
OAT!: _ _ _ __
GrtiEVANC! KAS BEEN PILED REGARDING TH2 rOLLOWING ISSUE:
PER AOHINISTlATIVI C%RICTIVI WI ARI SOLICITING OPINIONS.
POLICY OR PROC!DUal 81 CHANCID?
Y!S
NO
-------
SROOLO THE ABOVt
EXPLAIN~ -----------------------------------------------------------
--
NAMI/NUMIIR/POSITION
NQ -~~-- 'r!Wia _ _ _
A'M'AC11MINT 4
Rl'l'tmN._CO_MPLI'ri.IL.i'OM_T.Q__PACXLI~_Y_ClU!VAHC_I_5_HC_1~11'r
coc
92!0
(04/04/91)
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