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Back to Forms for 'Employee Management'.


GRIEVANCE FORM

GRIEVANCE FORM

 

Date: _____________________

 

Name of Employee: ________________________

 

Department: ______________________________

 

State your grievance in detail, including the date of act(s) or omissions causing grievance. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

 

Identify other employees with personal knowledge of your grievance. ____________________________________________________________________ ____________________________________________________________________

 

State briefly your efforts to resolve this grievance.  ____________________________ ____________________________________________________________________

 

Describe the remedy or solution you would like.  _____________________________ ____________________________________________________________________

 

 

Employee's Signature: _________________________                  Date: _____________

 

 

Grievance Team Member - Informal Review Date Received: ______________________ ______________________________________________________________________.

Actions Taken: _________________________________________________________ _____________________________________________________________________.

 

Disposition: ___________________________________________________________

 

Employee Accepted       [ ]                                    Employee Appealed         [ ]

 

Assigned Team Member: _____________             Date Communicated: _____________

 

Grievance Team - Formal Review

Date Received: _________________________________________________________

 

Actions Taken: _________________________________________________________ ______________________________________________________________________

 

Disposition: ___________________________________________________________

 

Employee Accepted       [ ]                                     Employee Appealed         [ ]

 

Grievance Review Team: _________________________________________________  Date Communicated: _________________________

 

Grievance Team and Management - Formal Review

 

Date Received: _________________________________________________________

 

Actions Taken: _________________________________________________________ _____________________________________________________________________

 

Disposition: ____________________________________________________________

Employee Accepted         [ ]                              Employee Appealed         [ ]

 

Management Team: ______________________________________________________  Date Communicated: __________________________

 



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