HomeMy WebLinkAboutADA-Grievance-Procedure-and-Complaint-Form-9.18.23COUNTY-CITY BUILDING
227 W. JEFFERSON BLVD.
SOUTH BEND, INDIANA 46601-1830
CITY OF SOUTH BEND, INDIANA
GRIEVANCE PROCEDURE
UNDER THE AMERICANS WITH DISABILITIES ACT (ADA)
The City of South Bend, Indiana, in accordance with the Americans with Disabilities Act ("ADA"), has adopted this
Grievance Procedure to insure prompt and equitable resolution of complaints alleging discrimination based on
disability in the provision of programs, services, benefits, or activities provided by the City of South Bend.
Employment related claims of disability discrimination are governed by the City’s Personnel Policies.
The steps in the City of South Bend’s Grievance Procedure are as follows:
1)File written Complaint using South Bend's form (attached) no later than 60 calendar days after the date of
the violation. Information must include:
a.Name, address, phone number, e-mail (if applicable) of person filing the grievance;
b.Name, address, phone number, e-mail (if applicable) of person alleging grievance on behalf of
someone else;
c.Date and approximate time violation occurred;
d.Narrative description of the violation;
e.Remedy or desired City corrective action.
2)South Bend’s ADA Coordinator will acknowledge the Complaint within 21 days from the date of filing.
The ADA Coordinator may meet with Complainant to discuss the Complaint and explore informal
resolution to the problem.
3)If an informal resolution is not reached, then within 30 days after initial response under Step 2, the ADA
Coordinator or Designee will respond in writing, and where appropriate, in a format accessible to the
Complainant such as large print, or audio tape. The response will explain City's position and offer options
for resolution of the Complaint.
4)If the ADA Coordinator's response does not satisfactorily resolve the issue, the Complainant and/or
his/her designee may appeal that decision. This appeal should be made to the Board of Public Works
President or designee within 15 days after receipt of the response of the ADA Coordinator, and this appeal
request must be made in writing.
5)The Board of Public Works President or designee shall meet with the Complainant within 15 days after
receipt of the appeal to discuss the Complaint and possible resolutions.
6)Within 15 days after that meeting, the Board Public Works President or designee will respond in writing,
and, where appropriate, in a format accessible to the Complainant, with a final resolution of the complaint.
The complaint should be submitted to:
ADA Coordinator
City of South Bend Legal Department
227 W. Jefferson Blvd., Suite 1200S
South Bend, IN 46601
Alternative means of filing Complaints such as personal interviews or a tape recording of the Complaint will be made
available upon request for persons with disabilities. All written Complaints received by the ADA Coordinator
or Designee or appeals to the Public Works Director or designee will be retained by the City of South Bend for a
period of three years.
ADA GRIEVANCE FORM
CITY OF SOUTH BEND, INDIANA
(Please write or print clearly)
Today’s Date: ____________________
Complainant Name: ________________________________
Address: _____________________________________________________________________________
City, State, Zip: ________________________________________________________________________
Telephone and E-mail: __________________________________________________________________
Individual Discriminated Against (If different from Complainant): ______
Address: _____________________________________________________________________________
City, State, Zip: ________________________________________________________________________
Telephone and E-mail: __________________________________________________________________
Date(s) & Approximate Time of Alleged Violation: ___________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Detailed Description of Violation and City Department Involved:
Requested Action by City to Correct Violation:
Has Complaint been filed with State or Federal Agency? YES___________ NO___________
Names of Agency: ____________________________________ Date Filed _______________________
Contact Person: ________________________________________________________________________
Signature: Date:
Please mail or deliver to: ADA Coordinator
City of South Bend Legal Department
227 W. Jefferson Boulevard - Suite 1200S
South Bend, IN 46601