Grievance Request Form

Be Advised

The guidelines for the grievance process are very specific and must be filled appropriately. As a result a grievance request must be submitted as soon possible, giving the union ten (10) full calendar days to review the documents and file your grievance in a timely manner with management. If a grievance request is submitted less then ten (10) days or last minute, your request will not be submitted. Please see CBA article 8.2.

I have read the statement above and I understand that I must provide the union ten (10) calendar days to process this request *

yes

I have read the terms listed in Article 8 - Grievance Procedure and Arbitration of the the CBA *

yes

Date of Incident *

Month

Day

Year

Date Write Up Received *

Month

Day

Year

Name *

Phone *

Email *

Employee ID Number *

Division *

Union Representative Contacted *

Describe the Incident *

Why Does This Incident Warrant a Grievance *

What Is Your Desired Outcome For This Grievance *

Copy of Write up Received *

pdf file only
Files must be less than 2 MB.
Allowed file types: pdf.

Copy of Incident Report *

pdf file only
Files must be less than 2 MB.
Allowed file types: pdf.

Signature

Signer Name *

By checking this box I understand that the Union has final say on what is to be grieved *

yes

Date *

Month

Day

Year

Leave this field blank

USW Local 1853

Grievance Request Form