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First Step Grievance Report

"*" indicates required fields

Grievance #*

Grievant Name*

Grievant Job Title*

Hire / Seniority Date*

Type of Grievance*

(Check one)

Discipline / Unfair Treatment

Contract Violation

Grievance Presented To*

(Name & Title of supervisor grievance request form given to)

Date Presented*

Date of First Step Meeting*

Date Received Company Answer to First Step*

Grievance Issue*

(Give brief description of issue grieved)

Company Answer with Detail*

(Denied / Settled)

State of the Grievance*

(Check one)

Settled satisfactorily

Closed

Denied

Director to Whom Grievance Should be Appealed*

Work Address of Director*

Street Address Address Line 2 City State ZIP Code

Name of Representative Filling Out Report*

Representative Telephone #*

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Name

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