GRIEVANCE INFORMATION FORM

 

 

 

WHO IS INVOLVED IN THE GRIEVANCE?

 

GRIEVOR

Text Box:   NAME _________________________________________EMP.NO_________________________   DEPARTMENT____________JOB/CLASS_____________________________RATE___________   SENIORITY: _____________PLANT SERVICE FROM (date)______________________________    _______________________DEPARTMENT SERVICE FROM (date)________________________   _______________________JOB SERVICE FROM (date)_________________________________

 

 

 

 

 


 

ALLEGATIONS

INVESTIGATIVE FACTS

RECOMMENDATIONS

FINAL DISPOSITION

 

 

 

FOREMAN OR OTHER MANAGEMENT INVOLVED

Text Box:   NAME: _______________________________________________DEPT _____________________     JOB TITLE_______________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 


 

WITNESSES OR OTHER PERSONS INVOLVED

Text Box:     NAME______________________________________________DEPT _______________________   JOB/CLASS______________________________________________________________________     NAME______________________________________________DEPT________________________   JOB/CLASS______________________________________________________________________     NAME______________________________________________DEPT _______________________   JOB/CLASS______________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 


 

WHAT HAPPENED?  WHAT IS THE GRIEVANCE ABOUT? (Make sure to include all points mentioned on the checklist for each type of grievance).

Text Box: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

WHEN DID THE GRIEVANCE OCCUR?  (Date and time grievance began?  How often?  For how long?   Is it within time limits to proceed with a grievance?)

Text Box: ______________________________________________________________________________________________________________________________________________________________________________________________________

 

 

 

 

 

 

 

 


 

WHERE DID THE GRIEVANCE OCCUR?  (Exact location – department, machine, aisle, job number, etc.  Include diagram, sketch or photo if helpful).

Text Box: ____________________________________________________________________________________________________________________________________

 

 

 

 

 

 

 


 

WHY IS THIS A GRIEVANCE?  (Violation of contract?  Supplement?  Law?  Past Practice?  Safety regulations?  Rulings or awards?  Unjust treatment?, etc.)

Text Box: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________