Forms & requests

Report something

Pick the one closest to what happened. If you’re not sure, choose Incident report. It goes to your supervisor and leadership, who’ll make sure it gets to the right place.

Emergency happening now? Call 911 first and keep everyone safe. Report it after.

Incident report Something happened at work. Goes to your supervisor and leadership the same day. For example

A client fell, got hurt, or had a medical or mental health emergency
A fight, a threat, or someone brought a weapon or drugs on site
A client overdosed, or you gave naloxone
A client left against advice, or a medication was given wrong
Client information was sent to the wrong person (wrong fax, email, or text)
Something broke that could hurt someone, or there was a fire or flood

Staff injury or exposure report You got hurt or exposed at work. Goes to your supervisor and leadership; medical details stay private. For example

A needlestick, or urine or blood splashed on you during a drug screen
You slipped in the parking lot or hurt your back lifting
A client hit or scratched you
You got sick from something at work

Harassment or workplace violence report Harassment or a threat against you. Goes only to the Executive Director and CEO, never your supervisor. Can be anonymous. For example

Unwanted comments, messages, or touching
A coworker threatened or intimidated you
You’re being treated differently because of your race, religion, age, disability, or sex
Someone is punishing you for reporting something

Grievance form A workplace problem you want resolved. Starts with your supervisor (or the Executive Director if it’s about your supervisor), with a written answer in 5 working days. For example

Your schedule or workload feels unfair
A pay or hours problem that hasn’t been fixed
A disagreement with your supervisor you couldn’t work out
A write-up or evaluation you think was wrong

Conflict of interest disclosure A relationship or side job leadership should know about. Only leadership sees it. Disclosing isn’t admitting anything. For example

A relative runs a recovery home, lab, or program we refer to
A lab or vendor rep offered you a gift or a meal
You have a second job or your own business
A client is your neighbor, relative, or friend

Suggestion box An idea or something that could be better. Goes to leadership. Anonymous if you want. For example

A better way to run intake or a group
Something in the building that needs fixing
A process that wastes everyone’s time

Shout-out A teammate did something great. Goes to them and leadership, and can be shared on staff home. For example

Someone covered your group on short notice
A coworker handled a crisis calmly

Still not sure? Pick Incident report, or talk to your supervisor or any member of leadership. Abuse of a child or vulnerable adult must also be reported to DCS (1-800-800-5556) or Adult Protective Services (1-800-992-6978).