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  • Oh Ethics Grievance Form 2024

Get Oh Ethics Grievance Form 2024-2026

Ohio Chemical Dependency Professionals Board 77 South High Street 16th Floor Columbus OH 43215 614-387-1110 phone 614 387-1109 fax www. ocdp.ohio. gov credentialing ocdp.state. oh. us ETHICS COMPLAINT FORM This form is to be used to file an ethics complaint against a Chemical Dependency Counselor CDCA LCDC II LCDC III or LICDC or a Prevention Specialist RA OCPSA OCPS I or OCPS II. Please provide as much detail as possible. Attach additional sheet.

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How to use or fill out the OH Ethics Grievance Form online

Filing an ethics grievance can feel daunting, but understanding the process can help you navigate it more smoothly. This guide provides a clear, step-by-step approach to filling out the OH Ethics Grievance Form online, ensuring you provide all necessary information to facilitate a thorough investigation.

Follow the steps to successfully complete the OH Ethics Grievance Form online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin the form by identifying yourself as the person filing the grievance. Fill in your name (optional), title, address, city, state, zip code, home phone, cell phone, and email.
  3. Next, provide details about the individual against whom you are filing the grievance. Include their name, employer, employer address, home address (if known), license type, and license number.
  4. Indicate whether you have voiced your complaint to the employer or followed their internal grievance process. Answer 'Yes' or 'No' and, if applicable, describe the outcome.
  5. Decide if you want to remain anonymous by selecting 'Yes' or 'No.' If you reference a client, remember to include a signed release of information (ROI) from them.
  6. Describe the conduct or behavior that forms the basis for your grievance on a separate sheet. Include relevant dates and any additional pertinent facts. Providing detailed information is crucial.
  7. Indicate which Code of Ethics you believe has been violated by the licensee or certificate holder.
  8. List additional persons who may have information pertinent to your grievance, including their names, phone numbers, and emails.
  9. Finalize your grievance by signing the form, affirming that all information is true to the best of your knowledge. Include the date.
  10. Now you can save your changes, download, print, or share the completed form as needed.

Ready to take action? Complete your OH Ethics Grievance Form online today.

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