Free Answering Brief in Opposition - District Court of Delaware - Delaware

Case 1 :04-cv-01378-GMS Document 41 -6 Filed 09/27/2005 Page 1 of 2
` FORM #534
GRIEVANCE FORM
FACIILI'E"\Y:__________________________________________ DATEC_______________________,___
GRIEVAN'I"S NAME: SBI.?
HOUSING UNIT;
BRIEFLY STATE THE REASON FOR THIS GRIEVANCE. GIVE DATES AND NAMES OF OTHERS INVOLVED
IN THE INCIDENT OR ANY WTTNESSES.

ACTION REQUESTED BY GRIEVANT:
GRIEVANTS SIGNATURE; DATE: ___________
WAS AN INFORMAL RESOLUTION ACCEPTED? _(YES) ___ (NO)
(COMPLETE ONLY IF RESOLVED PRIOR TO HEARING)
GRIEK/ANT’S SIGNATURE: DATE:
UNRESOLVED, YOU ARE I]N`H`ITLED TO A HEARING EY TIEIE RESICEIENT GRIEVANCE COMMITTEE.
·s:¤:; INSWITIUTION ILE
G RTIEZIYAN
Apuréél ’9’7 REV

Case 1:04-cv-01378—G|\/IS Document 41-6 Filed 09/27/2005 Page 2 of 2
Instructions for Submitting a Regular Grievance
Inmates are required, per DOC Procedure &.e [Inmate Grievance Procedure] to attempt to
resolve complaints prior to filing a regular grievance. Grievances are to be submitted
within seven(7) days from the date of the occurance or incident or within seven days
after the inmate became aware of the incident. The grievance is to be placed in the
grievance box located in each housing unit.
Only one issue per grievance form will be addressed. lf the grievance is submitted on a
weekend or a holiday, it will be recieved during the next working day.
Return of Unprocessed Grievance
Intake Action: This Grievance Form is being returned to the inmate under the provisions
outlined in DOC Procedure e.& "Inmate Grievance Procedure" for the following reason(s);
Vulgar/Abusive or Threatening Language. The language that is unacceptable has
been highlighted. The grievance may be resubmitted omitting this language.
N0n·Grievable. This issue has been defined as non—grievable in accordance with
DOC Policy Q.e. These procedures have their own appeal process that must be
followed. Disciplinary Action Parole Decision
v__ Classification Action
Request. Requests are not processed through the grievance procedure. Please
correspond with the appropriate office to secure the information that is
requested.
Duplicate Grievance(s). This issue has been addressed previously in
Grievance # .
Original Grievances must be submitted to the Inmate Grievance Chairperson.
Photocopies are not accepted,
Inquiry on behalf of other inmates. inmates cannot submit grievances for
other inmates.
Expired filing period- Grievance exceeds seven(7) days from date of occurrence.
inmate Grievance Chairpersonm—_ Date
Form#: 58e (F&B)
(Reverse Revised July 'QQ)