Grievance Fact Sheet
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. Use additional pages to document all the details. DO NOT TURN THIS FORM INTO MANAGEMENT. This information is for the Union's use only.
EMPLOYER
DEPT
WORK LOCATION
GRIEVANT
First Name
Last Name
ID #
What Happened? Also, describe incident that gave rise to the grievance.
Who was involved? Give names and titles
When did it occur? Give day, time, and date(s)
Were there any witnesses? Give names and titles - Get a signed statement if possible.
Where did it occur? Specific locations
Why is this a grievance? What is management violating: contract, rules & regulations, unfair treatment, existing policy, past practice, local, state, federal laws, etc.
Article
Section
Page
What adjustment is required? What must management do to correct the problem?
Step 1 Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
(Employee resolve complaint, i.e. Steward, Coach)
Step 2 Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
(Employee and steward confer with their leader, reduce to writing)
Step 3 Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
(Grievance with Company)
Grievant's Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grievant's Home address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grievant's Home Ph:
Format: (000) 000-0000.
Work Ph:
Format: (000) 000-0000.
Alt Ph:
Format: (000) 000-0000.
Steward's Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Steward's Home Ph:
Format: (000) 000-0000.
Work Ph:
Format: (000) 000-0000.
Alt Ph:
Format: (000) 000-0000.
A copy of this form is to be completed by the Steward or Officer filing the grievance and to be turned into the local.
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Submit
Should be Empty: