EMPLOYEE GRIEVANCE FORM Sample Clauses

EMPLOYEE GRIEVANCE FORM. INSTRUCTIONS: Sections 1 through 9 must be completed by the grievant (please type or print). One copy of this form must be submitted to the respondent. The appropriate grievance procedure for your respective unit must be followed.
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EMPLOYEE GRIEVANCE FORM. NAME CLASSIFICATION DATE Description of Problem: (statement of facts and circumstances giving rise to the grievance): Contract Section Grieved: Remedy Sought: LEVEL 1 DISCUSSION IMMEDIATE SUPERVISOR Results: Immediate Supervisor Date Grievant Date Signatures:
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EMPLOYEE GRIEVANCE FORM. (Refer to Article IX of the STA Contract) NAME: CLASSIFICATION: DATE: Description of Problem: GRIEVANCE-DISCUSSION OF CONFERENCE – LEVEL I (To be filed within 30 instructional days from the day of the alleged violation) Principal: Date: Grievant Signature: Date: GRIEVANCE – WRITTEN GRIEVANCE SUBMITTED – LEVEL II Action Requested: Grievant Signature: Date: Principal’s Decision: Signature: Date: GRIEVANCE – SUPERINTENDENT – GRIEVANT CONFERENCE – LEVEL III Date Grievance Received: Facts and Discussion: Date of Conference: Superintendent’s Decision: Superintendent’s Signature: Date: GRIEVANCE: ADVISORY ARBITRATION – LEVEL IV Written Request for Advisory Arbitration Received on: Findings: Advisory Recommendations: Hearing Date: Advisory Arbitrator Signature Date: GRIEVANCE – FINAL DECISION BY GOVERNING BOARD Date Received: Decision:
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EMPLOYEE GRIEVANCE FORM. This form is to be filled out by an employee who is dissatisfied with an aspect of his/her treatment for an occupational injury or with a situation involving the OMCA managed care program. By completing this form you are filing a grievance which will be reviewed and addressed by members of our administrative staff. Every effort will be made to accommodate reasonable requests. Please submit your written statement on the following lines within thirty (30) days of the occurrence of the event giving rise to the grievance. OMCA will render a written decision within thirty (30) days of receipt of this grievance. FACILITY WHERE YOU WERE TREATED NAME OF PROVIDER DATE OF OCCURRENCE COMPLAINT I agree to allow XXXX’s administrative staff to discuss my complaint with any parties involved. Company Name Your Name (please print) Address street address city state zip Signature Date PLEASE RETURN TO:Occupational Managed Care Alliance, Inc. ATTN: CLIENT SERVICES DEPARTMENTP.O. Box 20908Louisville, KY 40250-0908 Per KAR 25:110 (5) (a) (b) Any employee or provider dissatisfied with XXXX’s resolution of a grievance may apply for review by an Administrative Law Judge by filing a request for resolution within thirty (30) days of the date of OMCA’s final decision. Upon review by the ALJ, the movant shall be required to prove that XXXX’s final decision is unreasonable or otherwise fails to conform with KRS chapter 342. Department of Workers' Claims 000 Xxxxxxxxxx Xxxxxx Frankfort, KY 40601 Telephone (000) 000-0000
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EMPLOYEE GRIEVANCE FORM. Grievant(s) Name(s) Date of Occurrence giving rise to the grievance (Grievance number if applicable) Site Date of Informal Discussion ******************************************************************************************************** STEP 1: Statement of Grievance (specific Article # in contract alleged to have been violated): _ Remedy Sought: Date submitted Signature of Grievant(s) Date received by Immediate Supervisor/Designee Date Due Immediate Supervisor’s Reply: Date Title Signature Date Received by Grievant(s) Signature Upon completion of this section, the grievant shall retain the original and present copies to appropriate District Representative or Immediate Supervisor and to the President of the Association or Chairperson. ******************************************************************************************************** STEP 2 Grievant Response to District Representative: Date submitted Signature of Grievant(s) Reply by District Representative: Upon completion of this section, the grievant shall retain the original and present copies to appropriate District Representative or Immediate Supervisor. Date Signature of District Representative ******************************************************************************************************** STEP 3 to the District Superintendent: Date submitted Signature of Grievant(s) Response to Grievant: _ Date Signature of Superintendent/Designee Upon completion of this section, copies shall be distributed as follows:
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EMPLOYEE GRIEVANCE FORM. Exhibit C ..........................................................................................................................................
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EMPLOYEE GRIEVANCE FORM. Formal Grievances filed under the employee grievance procedure will use the Employee Grievance Form provided in this Article, or other written format for that purpose, to ensure the orderly processing of the grievance. A grievance submitted in a written format other than the Employee Grievance Form should contain the information indicated by the Employee Grievance Form.
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EMPLOYEE GRIEVANCE FORM. NAME CLASSIFICATION DATE Description of Problem: (statement of facts and circumstances giving rise to the grievance): Contract Section Grieved: Remedy Sought: LEVEL 1 DISCUSSION IMMEDIATE SUPERVISOR Results: Signatures: Immediate Supervisor Date Grievant Date LEVEL 2 WRITTEN GRIEVANCE Action Requested: Grievant Signature Date Supervisor’s Decision: Signature Date Received Date of Response LEVEL 3 SUPERINTENDENT/GRIEVANT CONFERENCE Date Grievance Received Date of Conference Facts and Discussion: Superintendent’s Decision: Superintendent’s Signature EMPLOYEE GRIEVANCE FORM Date LEVEL 4 APPEAL TO BOARD OF TRUSTEES Date Appeal Received Date Regularly Scheduled Board Meeting Decision: Board President’s Signature Date LEVEL 5 ADVISORY ARBITRATION Date Advisory Arbitration Request Received _ Findings: Advisory Recommendations: Hearing Date Advisory Arbitrator’s Signature Date LEVEL 6 FINAL DECISION BY GOVERNING BOARD Date Arbitrator’s Recommendations Received _ The Governing Board has the right and responsibility of a final decision in regard to grievance. Governing Board’s Decision: Date Public Action Taken Board President’s Signature Appendix H Important Dates STA Contract Dates Date Contract Article and Section Description Month Day August 10 Transcripts or letters of verification due September 30 29 District to provide “Statement of Accrued Sick Leave”
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Related to EMPLOYEE GRIEVANCE FORM

  • Grievance Form The grievance form which must be used for filing of grievances shall be provided by the District. Such form shall be readily accessible in all school buildings or electronically available on the District’s website. (See Attachment B – Grievance Form)

  • Grievance Forms Each grievance, request for review, and notice of arbitration must be submitted in writing on the appropriate form attached as Appendices C, D and E to this Agreement and shall be signed by the grievant. All grievance forms shall be dated when the grievance is received. If there is difficulty in meeting any time limit, the UFF representative may sign such documents for the grievant; however, grievant's signature shall be provided prior to the Step 2 meeting.

  • Employee Grievance If an employee considers there has been a significant change to the job content of the position held, the employee may initiate a grievance by using Step 1 of the Grievance Procedure. If the issue is not resolved at this step, the Job Classification Review Procedure of Article 22.02(B) above shall be utilized.

  • Employee Grievance Procedure 91. An employee having a grievance may first discuss it with the employee's immediate supervisor, or the next level in management, to try to work out a satisfactory solution in an informal manner. The employee may have a representative(s) at this discussion.

  • Policy Grievance – Employer Grievance The Employer may institute a grievance alleging a general misinterpretation or violation by the Union or any employee by filing a written grievance with the Bargaining Unit President, with a copy to the Labour Relations Officer within twenty (20) days after the circumstances have occurred. A meeting will be held between the parties within ten (10) days. The Union shall reply within ten (10) days after the meeting, and failing settlement, the matter may be referred to arbitration.

  • Employee Grievances 3.2(a) Grievances on behalf of employees shall be handled as follows:

  • Policy Grievance – Union Grievance The Union may institute a grievance alleging a general misinterpretation or violation of this Agreement by the Employer by submitting a written grievance at Step No. 1 within twenty (20) days after the circumstances have occurred. This section shall not apply to disciplinary grievances or application of competitive clauses under this Agreement.

  • Formal Grievance - Step 2 A. If the grievant is not satisfied with the decision rendered pursuant to Step 1, the grievant may appeal the decision within twenty-one (21) calendar days after receipt to a designated supervisor or manager identified by each department head as the second level of appeal. If the department head or designee is the first level of appeal, the grievant may bypass Step 2.

  • Individual Grievance Subject to clause 17.5 and as provided in section 208 of the PSLRA, an employee is entitled to present a grievance in the manner prescribed in clause

  • Formal Grievance - Step 1 A. If an informal grievance is not resolved to the satisfaction of the grievant, a formal grievance may be filed no later than:

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