United Teachers of Dade Pre-Grievance Form
Filing this form does NOT constitute a Grievance. Upon receipt of this form, your UTD Organizer will review the allegation and the evidence provided. If a violation can be established, the Organizer will attempt informal resolution as required by contract. Only after a violation has been established and informal resolution has failed will a Grievance be filed.
Member Name:
*
Employee Number:
*
Member at time of incident
*
Yes
No
Join Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Cell Telephone #
*
Format: (000) 000-0000.
Work Telephone #
*
Format: (000) 000-0000.
Work Telephone # Extention(If Aplicable)
E-Mail Address:
*
example@example.com
Home Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Wk Loc.#
*
Work Location Name:
*
Position / Job Title:
*
M-DCPS Hire Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Building Steward Name:
Steward contacted
*
Yes
No
Supervising Principal/Administrator:
*
Contract Section Violated: (required) Article:
*
Rows
Article
Section
Letter
Contract Section Violated
Date Grievance occurred:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date UTD Notified:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
30th Working Day from Violation:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Nature of Violation: (attach detailed narrative)
*
Witnesses to violation or persons with pertinent information: (attach witness(es) statements with signature)
Witnesses to violation
Rows
Name
Contact information:
Witnesses 1
Witnesses 2
Witnesses 3
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United Teachers of Dade Pre-Grievance Form
Filing this form does NOT constitute a Grievance. Upon receipt of this form, your UTD Organizer will review the allegation and the evidence provided. If a violation can be established, the Organizer will attempt informal resolution as required by contract. Only after a violation has been established and informal resolution has failed will a Grievance be filed.
Pertinent Evidence/Documentation: (please attach copies of all evidence)
Pertinent Evidence/Documentation:
Rows
Date Generated:
Date Obtained by Grievant
Generated By:
Received By:
Description:
Relevance to Grievance:
Document 1
Document 2
Document 3
Informal resolution sought by:
*
Date for Informal resolution:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Informal resolution sought with:
*
Response from Administration: (Please attach emails or detailed narrative of discussions)
*
Pertinent Evidence/Documentation: (please attach copies of all evidence)
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