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Environmental & social grievance form
Section 1: About you
Your name or organisation
Do you want to remain anonymous throughout the process?
Yes
No
Do you believe there is any risk of retaliation for raising this concern?
Yes
No
Area or city where the project is based
Section 2: About the project
Project name
Company involved
Briefly describe what the project does or its main activities
Section 3: What's happened or could happen
What type of harm are you concerned about?
Air or water pollution
Hazardous waste mismanagement
Unsafe working conditions
Community health risks
Violation of workers' rights
Disruption to local heritage or land
Other (please specify)
Is this a current issue or a possible future concern? Please share when it started and whether it is ongoing.
Tell us more about what happened. Please include details such as dates, how often it has happened, and who is affected. You can attach any evidence, such as photos or documents, if available.
Section 4: Actions taken and what you'd like to see
Have you raised this concern before with the company or with us?
Yes
No
What outcome would you like to see from submitting this form?
Section 5: How to contact you
Preferred way to contact you
By phone
By email
Section 6: Our role in the project
How do you think we are involved with the project or company?
We provide financing
We are in a partnership
It is our own project
I'm not sure
Other (please specify)
Note: We aim to acknowledge grievance forms within 15 business days and provide a final response within 60 days, where applicable.
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