GRIEVANCE FACT SHEET TEMPLATE

GRIEVANT INFORMATION
GRIEVANT NAME
HOME ADDRESS
DEPARTMENT
CLASSIFICATION
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 and time
WHERE DID IT OCCUR? Specific locations
WHAT HAPPENED? Describe the event in detail. Also, describe any incidents giving rise to the grievance.
WHY IS THIS A GRIEVANCE? List all policies, procedures, and guidelines violated in the event described.
WHAT ADJUSTMENT IS REQUIRED? Describe what must be done to correct the situation / problem.
ADDITIONAL COMMENTS Attach sheets, if needed.

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