This form is to be used by the steward to aid in investigating a grievance. The FACT SHEET outlines the information that will be necessary to develop a strong case. Please fill out this form COMPLETELY. Be sure to submit this form promptly(within a couple of days of infraction), as there are strict time frames the Local must follow in filing a grievance.

Grievant:

Your name

Department:

Official Title:

Functional Title:

Date of Hire:

Work Location:

What Happened (Also describe incidents which gave rise to the grievance.):

Who was involved? Give names and titles (include witnesses):

When did it occur? Give day, time, date(s):

Where did it occur? Specific locations:

Why is this a grievance?:

What is management violating: contract, rules and regulations, unfair treatment, existing policy, past practice, local, state, federal laws, etc.

What adjustment is required? What must management do to correct the problem?:

Additional comments.:

Your Street Address:

City:

State:

ZIP:

Phone:

Email: