DELGADO COMMUNITY COLLEGE
Problem Solving Meeting Summary Form

DELGADO COMMUNITY COLLEGE

Problem Solving Meeting Summary Form

Purpose of this form: If an employee submits Form 2534/001, Notification of Problem Form, regarding an alleged violation of College policy and procedure or a problem affecting his/her working conditions the Mediator calls a meeting with the employee and the respondent(s). To document the discussion, this form is completed and signed by all parties involved at the end of the Step 1 meeting. Additional pages and/or documentation may be attached, if needed.

Date of Meeting with Mediator: _____________________

Name of Employee Requesting Meeting: _________________________________
Dept./Division: _____________________________________________________________
Name of Intermediate Supervisor: ______________________________________________
Name of Immediate Supervisor: _______________________________________________
Name of Respondent(s): _________________________________________________________________________

Steps Recommended by the Mediator to Remedy the Problem:

I recommend the remedy listed above.

______________________________________
Signature of Mediator

_____ I accept the recommended remedy. (Or) ______ I disagree for the following reason(s):

____________________________________
Signature of Employee Requesting Meeting

_____ I accept the recommended remedy. (Or) ______ I disagree for the following reason(s):

_______________________________
Signature of Respondent

(Copy of completed forms 2534/001 and 2534/002 must be attached to this form.)

Form 2534/003 (5/17)