GRIEVANCE AND HARASSMENT FORM

When you file a complaint for harassment or a grievance against any one at the local hiring hall, or on the job and you fail to cooperate in the investigation or failed to appear at the hearing without good cause, the complaint shall be dismissed for failure to prosecute. If you file a frivolous harassment or grievance complaint against any one at the local hall, or on the job, disciplinary sanctions, may be imposed.

EMPLOYEE NO 1423:
Name Name First Last
Email
Phone Phone - ### - ### ####
Address Address
Street Address City State / Province / Region Postal / Zip Code
GRIEVANCE INFORMATION

SUBMIT DETAILS
TYPE OF GRIEVANCE
GRIEVANCE ON:
PLACE ,TIME AND DATE OF GRIEVANCE
PLACE OF GRIEVANCE
Time Time : HH MM AM/PM
Date Date / MM / DD YYYY
Explain in detail of what transpired.
Do you have witnesses?
WITNESS(ES) NAME AND NUMBER
Name Name First Last
Phone Phone - ### - ### ####
Name Name First Last
Phone Phone - ### - ### ####
Name Name First Last
Phone Phone - ### - ### ####
GRIEVANCE FILED BY
EMPLOYEE NO 1423:
Your Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
FOR OFFICALS
REVIEWED BY

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Time Time : HH MM AM/PM
Date Date / MM / DD YYYY
RANK AND FILE OFFICER

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

GRIEVANCE AND HARASSMENT FORM

GRIEVANCE AND HARASSMENT FORM

GRIEVANCE INFORMATION

PLACE ,TIME AND DATE OF GRIEVANCE

WITNESS(ES) NAME AND NUMBER

FOR OFFICALS