"Grievance Form - Liuna"

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Grievance Form
Name of Grievant:_______________________
Work Unit:_________________
Department:_____________________
Date:______________
Name of Steward:_________________
Nature of Grievance:____________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(attach additional sheets if needed)
Settlement Desired:_____________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
:________________________
Signature of Employee
Step 1
Step 2
Date Submitted:___________
Date Submitted:__________
Submitted to:_____________
Submitted to:______________
Date of Response:__________
Date of Response:__________
Was Grievance Resolved? Yes/No
Was Grievance resolved? Yes/No
Step 3
Step 4
Date Submitted:___________
Date Submitted:__________
Submitted to:_____________
Submitted to:______________
Date of Response:__________
Date of Response:__________
Was Grievance Resolved? Yes/No
Was Grievance resolved? Yes/No
UNION USE ONLY
Date submitted for arbitration:_______________
Local#__________
Name of arbitrator:_________________________
Grievance Form
Name of Grievant:_______________________
Work Unit:_________________
Department:_____________________
Date:______________
Name of Steward:_________________
Nature of Grievance:____________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(attach additional sheets if needed)
Settlement Desired:_____________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
:________________________
Signature of Employee
Step 1
Step 2
Date Submitted:___________
Date Submitted:__________
Submitted to:_____________
Submitted to:______________
Date of Response:__________
Date of Response:__________
Was Grievance Resolved? Yes/No
Was Grievance resolved? Yes/No
Step 3
Step 4
Date Submitted:___________
Date Submitted:__________
Submitted to:_____________
Submitted to:______________
Date of Response:__________
Date of Response:__________
Was Grievance Resolved? Yes/No
Was Grievance resolved? Yes/No
UNION USE ONLY
Date submitted for arbitration:_______________
Local#__________
Name of arbitrator:_________________________

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