Grievant Information

    Grievant Name

    Home Address



    Date Of Hire

    Date Of classification

    Work Location

    Details of Event Leading To Grievance

    Who was involved?

    Provide names and titles include witnesses

    When did it occur?

    Date & Time

    Where did it occur?

    Specific Location

    What Happened?

    Describe the event in detail. Also describe any incidents giving use to the grievance.

    Why is this a Grievance

    List all policies procedures and guidlines violated in the event described.

    What adjustment is required?

    Describe what must be done to correct the situation / problems.

    Additional Comments