Grievance Form

Name of Employee (Grievant): Required

Employer: Required

Job Class/Title: Required

Department and Work Location: Required

Name of Direct Supervisor: Required

Remedy Sought (What employer action will resolve this grievance to make the grievant whole): Required

Statement of Grievance (Write the nature and the facts of the grievance: who, what, where, when, why): Required

Contract Violations (List all Contract Articles and how they were violated and all other applicable articles): Required

Work Location of person submitting form Required

First and Last Name of person submitting form Required

Cell phone / email of person submitting form Required

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