COMPLAINT - GRIEVANCE FORM
LOCAL LODGE NO. 839
GRIEVED EMPLOYEE NAME:
EMPLID:
ADDRESS:
HOME PHONE:
MANAGER:
DATE:
CITY:
SHIFT:
_STATE:
WORK PHONE:
ZIP:
SENIORITY DATE:
DEPT:
JOB CODE:
BUILDING:
POST:
SUBMITTED BY SIGNATURE:
SUBMITTED BY PRINT NAME:
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------COMPANY REPRESENTATIVE AND STEWARD OR IN-PLANT DECISION:
DATE:
DATE:
COMPANY REPRESENTATIVE (SIGNATURE)
STEWARD/IN-PLANT REPRESENTATIVE (SIGNATURE)
COMPANY REPRESENTATIVE (PRINT)
STEWARD/IN-PLANT REPRESENTATIVE (PRINT)
WAS COMPLAINT SETTLED?
YES
NO
WAS EMPLOYEE NOTIFIED OF DECISION?
YES
NO
_
IN-PLANT REPRESENTATIVE’S STATEMENT:
After a thorough investigation by both the Union and the Company, it is agreed to:
DATE:
DATE:
COMPANY REPRESENTATIVE (SIGNATURE)
IN-PLANT REPRESENTATIVE/BUSINESS REPRESENTATIVE (SIGNATURE)
COMPANY REPRESENTATIVE (PRINT)
IN-PLANT REPRESENTATIVE/BUSINESS REPRESENTATIVE (PRINT)
IN-PLANT REPRESENTATIVE/BUSINESS REPRESENTATIVE’S STATEMENT:
After a thorough investigation by both the Union and the Company, it is agreed to:
DATE:
DATE:
COMPANY REPRESENTATIVE (SIGNATURE)
IN-PLANT REPRESENTATIVE/BUSINESS REPRESENTATIVE (SIGNATURE)
COMPANY REPRESENTATIVE (PRINT)
IN-PLANT REPRESENTATIVE/BUSINESS REPRESENTATIVE (PRINT)