Who is involved
Name______________________________________
Check No___________ Department_______________________________________
Job
and Class__________________________________ Rate____________
Seniority Plant Service (date)_____________________
FLL or Management Involved
Name______________________________________ Department________________________________
Title________________________________________
Witnesses or Other Persons Involved
Name____________________________________________ Department_______________________________________
Job
and Class__________________________
Phone Number_________________
Name____________________________________________ Department_______________________________________
Job
and Class__________________________
Phone Number_________________
Name____________________________________________ Department_______________________________________
Job
and Class__________________________
Phone Number________________
What happened? What is the grievance about? Make sure
to include all points mentioned on the checklist for reach type of grievance.
When did the grievance occur? (date and time grievance began.
How often ? for how long? Is it within the time limits to proceed with a grievance?
Where did the grievance occur? (exact location-department,
machine, aisle, job number, etc. Include diagram, sketch or photo.
Why is this a grievance? (Violation of contract? Supplement?
Law? Past Practice? Safety Regulation? Rulings or Awards? Unjust treatment ? Local Rule? Etc
Want grievance settled and redress in full,
adjustments necessary to completely correct situation: In case of discharge ask for back pay.
Company Contends
Company record of conduct. Warning and or penalties for lateness, attendance, quantity
or quality of work.
Dates Reasons
Verbal Warnings issued________________ ____________________________
Written Warnings Issued________________ ____________________________
Penalties Imposed________________ ____________________________
Additional Information Information given by witnesses.
Print the name of each witness followed by a summary of what each saw and get a signed statement if necessary.
Documentary Evidence : Seniority lists, wage schedules, work ticket, record of
similar grievances, rule violated etc
Date:_____________ Signature of steward___________________________
Local 90 Union Fact Sheet
