| COMPLAINANT | STREET ADDRESS | CITY | STATE | ZIP CODE | OEO NUMBER | CASE NO. | REP'S STREET ADDR. | REP'S CITY ADDR. | REP'S STATE ADDR. | REP'S ZIP CODE | COUNSELOR'S NAME | DATE OF INCIDENT | DATE INITIAL CONTACT/INTERVIEW | DATE NOTICE OF FINAL INTERVIEW | DATE OF INFORMAL RESOLUTION | DATE EXTENSION REQUESTED | LENGTH OF EXTENSION GRANTED | DATE FORMAL COMPLAINT FILED | DATE UNION GRIEVANCE FILED | DATE MSPB APPEAL FILED | DATE COUNS. INFORMED OF F.C. | DATE COUNSELOR FILED REPORT | ISSUE CODES | BASIS | ISSUE CODE COMMENTS | STATION | SERVICE | POSITION/GRADE | JOB TITLE | NARRATIVE INFORMATION | CORRECTIVE ACTION | REP'S NAME | REP'S PHONE NO. | COUNSELOR SECURITY |
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