HomeMy WebLinkAboutFC-03 - Employee Grievance Form
STEP 1. (Formal presentation of grievance)
Employees may be entitled to representation under the grievance procedure.
NAME OF GRIEVANT
DATE FILED WITH SUPERVISOR
DEPARTMENT
DIVISION
JOB TITLE
SUPERVISOR
WHAT OCCURRED (Please describe the incident, be specific)
DATE INCIDENT OCCURRED
WHAT RULE OR REGULATION WAS VIOLATED
SPECIFIC REMEDY REQUESTED
I DISCUSSED THIS INFORMALLY WITH MY SUPERVISOR ON
GRIEVANT’S SIGNATURE
COPY OF GRIEVANCE SENT TO LABOR RELATIONS
YES
NO
FC-03
STEP 2
FORMAL REVIEW BY SUPERVISOR
DATE RECEIVED
TIMELINES EXTENDED BY MUTUAL AGREEMENT
(Yes)
Date
(No)
DECISION
SUPERVISOR’S SIGNATURE
DATES DELIVERED TO GRIEVANT
THE ABOVE DECISION IS ACCEPTABLE
I REQUEST FURTHER REVIEW BY MY DEPARTMENT HEAD
GRIEVANT’S SIGNATURE
DATE
STEP 3
REVIEW BY DEPARTMENT HEAD
DATE RECEIVED
TIMELINES EXTENDED BY MUTUAL AGREEMENT
(Yes)
Date
(No)
DECISION
DEPARTMENT HEAD’S SIGNATURE
DATES DELIVERED TO GRIEVANT
THE ABOVE DECISION IS ACCEPTABLE
I REQUEST FURTHER REVIEW BY THE GRIEVANCE ADVISORY COMMITTEE
GRIEVANT’S SIGNATURE
EMPLOYEE ORGANIZATION/REVIEW COMMITTEE APPROVAL (If required) Yes No
DATE
DATE DELIVERED TO LABOR RELATIONS
FC-03
STEP 4
REVIEW BY GRIEVANCE ADVISORY COMMITTEE
GRIEVANCE HEARING DATE
RECOMMENDATION
COMMITTEE CHAIRPERSON’S SIGNATURE
DATE DELIVERED TO CITY MANAGER
STEP 5
DECISION BY CITY MANAGER
DATE RECEIVED
DECISION
CITY MANAGER’S SIGNATURE
DATE DELIVERED TO EMPLOYEE