Non-Escalation Consent Form
Please complete this form to confirm your agreement to pursue direct resolution and not escalate the issue.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Team
Date of Submission
*
-
Month
-
Day
Year
Date
Issue Description
*
Preferred Method for Direct Resolution
*
In-person discussion
Phone call
Email correspondence
Other
Have you previously attempted to resolve this issue directly?
*
Yes
No
Please describe the direct resolution steps you plan to take.
*
Submit Consent
Should be Empty: