Common use of GRIEVANCE REPORT FORM Clause in Contracts

GRIEVANCE REPORT FORM. PLEASE PRINT OR TYPE A copy of this form must be sent to the O.L.C. Office - IMMEDIATELY Please have your Associate call your Staff Representative when Name of Grievant Badge No. Grievant address Phone No. ( ) Classification Assignment Shift Date of appointment Immediate Supervisor at time of incident O.L.C. Representative Date and time Grievance first discussed with Date and time Article and section number of contract violation Statement of grievance (Give times, dates, who, what, when, where, why, and how): Remedy requested: Grievant’s signature Date and time STEP ONE Received by Date and time Respondent Name and Title Date of meeting Time Place Step one response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected STEP TWO if applicable Received by Date and time Respondent Name and Title Date of meeting Time Place Step two response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected STEP THREE if applicable Received by Date and time Respondent Name and Title Date of meeting Time Place Step three response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected STEP FOUR if applicable Received by Date and time Respondent Name and Title Date of meeting Time Place Step four response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected F.O.P./O.L.C. intention to arbitrate (Yes) (No) Signature APPENDIX G PATROL SHIFT BID FORM SHIFT BID PERIODS: On or about January 1st thru April 30th On or about May 1st thru August 31st On or about September 1st thru December 31st YEAR: 2019 2020 2021 EMPLOYEE: On or about January 1st thru April 30th Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about May 1st thru August 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about September 1st thru December 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): Patrol officers will be allowed to bid on a preferred shift assignment each calendar year by seniority. Number the shift bids 1-3 by preference with #1 being the first requested. This form must be submitted by October 1st prior to the year of the bid shifts. Patrol officers not completing this form by the deadline or choosing not to complete the form will be assigned an un-bid shift by the City. Patrol officers will not be allowed to remain on a preferred shift for more than two consecutive cycles regardless of the calendar year (For example, an officer serving on a preferred shift in the second and third cycles may not remain on that shift for the first cycle of the following year). This shift bid system shall be in effect for each year of this agreement. APPENDIX H HURON POLICE DIVISION HOLIDAY COMPENSATION ELECTION FORM Employee Name: Select one of the following designations for the distribution of holiday compensation in accordance with Article 20 of the collective bargaining agreement: Holiday Time Off: Holiday Cash Payment:

GRIEVANCE REPORT FORM. PLEASE PRINT OR TYPE A copy of this form must be sent to the O.L.C. Office - IMMEDIATELY Please have your Associate call your Staff Representative when filing a grievance Name of Grievant Badge No. Grievant address City , State, Zip: Grievant Phone No. ( ) #: Grievant Email: Grievant Cell #: Classification Assignment Shift Date of appointment Immediate Supervisor at time of incident O.L.C. Representative Date and time Grievance first discussed with Date and time Article and section number of contract violation Statement of grievance (Give times, dates, who, what, when, where, why, and how): Remedy requested: Grievant’s signature Date and time STEP ONE Received by Date and time Respondent Name and Title Date of meeting Time Place Step one response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected STEP TWO if applicable Received by Date and time Respondent Name and Title Date of meeting Meeting Time Place Step two response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected STEP THREE (if applicable applicable) Received by Date and time Respondent Name and Title Date of meeting Meeting Time Place Step three response Name and Title Date and Time Received by Grievant Signature Date and Time ANSWER IS: Accepted Rejected STEP FOUR if applicable Received by Date and time Respondent Name and Title Date of meeting Meeting Time Place Step four response Name Signature and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected F.O.P./O.L.C. intention to arbitrate (Yes) (No) Signature APPENDIX G PATROL SHIFT BID FORM SHIFT BID PERIODS: On or about January 1st thru April 30th On or about May 1st thru August 31st On or about September 1st thru December 31st YEAR: 2019 2020 2021 EMPLOYEE: On or about January 1st thru April 30th Day shift A (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about May 1st thru August 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about September 1st thru December 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): Patrol officers will be allowed to bid on a preferred shift assignment each calendar year by seniority. Number the shift bids 1-3 by preference with #1 being the first requested. This form must be submitted by October 1st prior to the year of the bid shifts. Patrol officers not completing this form by the deadline or choosing not to complete the form will be assigned an un-bid shift by the City. Patrol officers will not be allowed to remain on a preferred shift for more than two consecutive cycles regardless of the calendar year (For example, an officer serving on a preferred shift in the second and third cycles may not remain on that shift for the first cycle of the following year). This shift bid system shall be in effect for each year of this agreement. CONTINUED) APPENDIX H HURON POLICE DIVISION HOLIDAY COMPENSATION ELECTION FORM Employee Name: Select one of the following designations for the distribution of holiday compensation in accordance with Article 20 of the collective bargaining agreement: Holiday Time Off: Holiday Cash Payment:A

GRIEVANCE REPORT FORM. PLEASE PRINT OR TYPE A copy of this form must be sent to the O.L.C. Office - COPY OF THIS FORM MUST BE SENT TO THE UNION IMMEDIATELY Please have your Associate call your Date and Time Staff Representative when Notified Name of Of Grievant Badge ID No. Grievant address Phone No. ( ) Classification Rank Assignment Shift Date of appointment Immediate Appointment Supervisor at time Time of incident O.L.C. Incident OPBA Representative Grievance First Discussed With Supervisor Meeting Date and time Grievance first discussed with Date and time Article and section number of contract violation Time Place STEP ONE Statement of grievance Grievance (Give timestime, dates, who, what, when, where, why, ): Article and how): Section Numbers of Contract Violations Remedy requested: Grievant’s signature Requested Xxxxxxxx's Signature Date and time Received By Date/Time Patrol/Detective Commander STEP ONE Received by Date and time Respondent Name and Title Date of meeting RESPONSE Patrol/Detective Commander’s Signature Date/Time Place Step one response Name and Title Date and Time Received by Grievant Date and Time STEP ONE ANSWER IS: Accepted Rejected Xxxxxxxx’s Signature Date STEP TWO if applicable Received by By Date/Time Chief of Police Meeting Date and time Respondent Name and Title Date of meeting Time Place Step two response Name and Title STEP TWO RESPONSE Chief of Police’s Signature Date and Time Received by Grievant Date and Time STEP TWO ANSWER IS: Accepted Rejected Xxxxxxxx’s Signature Date STEP THREE if applicable Received by By Date and time Respondent Name and Title Director of Human Resources Meeting Date of meeting Time Place Step three response Name and Title STEP THREE RESPONSE Director of Human Resource’s Signature Date and Time Received by Grievant Date and Time STEP THREE ANSWER IS: Accepted Rejected Xxxxxxxx’s Signature Date Referred To OPBA Representative: Yes No Date Referred Approved Disapproved By OPBA Representative (Signature) STEP FOUR if applicable Received by Date and time Respondent - ARBITRATION Notice Served For Arbitration (Name and Title Title) Date of meeting Time Place Step four response Arbitration Notice Received (Name and Title Title) Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected F.O.P./O.L.C. intention to arbitrate (Yes) (No) Signature APPENDIX G PATROL SHIFT BID FORM SHIFT BID PERIODS: On or about January 1st thru April 30th On or about May 1st thru August 31st On or about September 1st thru December 31st YEAR: 2019 2020 2021 EMPLOYEE: On or about January 1st thru April 30th Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about May 1st thru August 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about September 1st thru December 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): Patrol officers will be allowed to bid on a preferred shift assignment each calendar year by seniority. Number the shift bids 1-3 by preference with #1 being the first requested. This form must be submitted by October 1st prior to the year of the bid shifts. Patrol officers not completing this form by the deadline or choosing not to complete the form will be assigned an un-bid shift by the City. Patrol officers will not be allowed to remain on a preferred shift for more than two consecutive cycles regardless of the calendar year (For example, an officer serving on a preferred shift in the second and third cycles may not remain on that shift for the first cycle of the following year). This shift bid system shall be in effect for each year of this agreement. APPENDIX H HURON POLICE DIVISION HOLIDAY COMPENSATION ELECTION FORM Employee Name: Select one of the following designations for the distribution of holiday compensation in accordance with Article 20 of the collective bargaining agreement: Holiday Time Off: Holiday Cash Payment:Supervisor

GRIEVANCE REPORT FORM. PLEASE PRINT OR TYPE A copy of this form must be sent to the O.L.C. Office - COPY OF THIS FORM MUST BE SENT TO THE UNION IMMEDIATELY Please have your Associate call your Date and Time Staff Representative when Notified Name of Of Grievant Badge ID No. Grievant address Phone No. ( ) Classification Rank Assignment Shift Date of appointment Immediate Appointment Supervisor at time Time of incident O.L.C. Incident OPBA Representative Grievance First Discussed With Supervisor Meeting Date and time Grievance first discussed with Date and time Article and section number of contract violation Time Place STEP ONE Statement of grievance Grievance (Give timestime, dates, who, what, when, where, why, ): Article and how): Section Numbers of Contract Violations Remedy requested: Requested Grievant’s signature 's Signature Date and time Received By Date/Time Patrol/Detective Commander STEP ONE Received by Date and time Respondent Name and Title Date of meeting RESPONSE Patrol/Detective Commander’s Signature Date/Time Place Step one response Name and Title Date and Time Received by Grievant Date and Time STEP ONE ANSWER IS: Accepted Rejected Grievant’s Signature Date STEP TWO if applicable Received by By Date/Time Chief of Police Meeting Date and time Respondent Name and Title Date of meeting Time Place Step two response Name and Title STEP TWO RESPONSE Chief of Police’s Signature Date and Time Received by Grievant Date and Time STEP TWO ANSWER IS: Accepted Rejected Grievant’s Signature Date STEP THREE if applicable Received by By Date and time Respondent Name and Title Director of Human Resources Meeting Date of meeting Time Place Step three response Name and Title STEP THREE RESPONSE Director of Human Resource’s Signature Date and Time Received by Grievant Date and Time STEP THREE ANSWER IS: Accepted Rejected Grievant’s Signature Date Referred To OPBA Representative: Yes No Date Referred Approved Disapproved By OPBA Representative (Signature) STEP FOUR if applicable Received by Date and time Respondent - ARBITRATION Notice Served For Arbitration (Name and Title Title) Date of meeting Time Place Step four response Arbitration Notice Received (Name and Title Title) Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected F.O.P./O.L.C. intention to arbitrate (Yes) (No) Signature APPENDIX G PATROL SHIFT BID FORM SHIFT BID PERIODS: On or about January 1st thru April 30th On or about May 1st thru August 31st On or about September 1st thru December 31st YEAR: 2019 2020 2021 EMPLOYEE: On or about January 1st thru April 30th Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about May 1st thru August 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about September 1st thru December 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): Patrol officers will be allowed to bid on a preferred shift assignment each calendar year by seniority. Number the shift bids 1-3 by preference with #1 being the first requested. This form must be submitted by October 1st prior to the year of the bid shifts. Patrol officers not completing this form by the deadline or choosing not to complete the form will be assigned an un-bid shift by the City. Patrol officers will not be allowed to remain on a preferred shift for more than two consecutive cycles regardless of the calendar year (For example, an officer serving on a preferred shift in the second and third cycles may not remain on that shift for the first cycle of the following year). This shift bid system shall be in effect for each year of this agreement. APPENDIX H HURON POLICE DIVISION HOLIDAY COMPENSATION ELECTION FORM Employee Name: Select one of the following designations for the distribution of holiday compensation in accordance with Article 20 of the collective bargaining agreement: Holiday Time Off: Holiday Cash Payment:Supervisor

GRIEVANCE REPORT FORM. PLEASE PRINT OR TYPE A copy of this form must be sent to the O.L.C. Office - COPY OF THIS FORM MUST BE SENT TO THE UNION IMMEDIATELY Please have your Associate call your Date and Time Staff Representative when Notified Name of Of Grievant Badge ID No. Grievant address Phone No. ( ) Classification Rank Assignment Shift Date of appointment Immediate Appointment Supervisor at time Time of incident O.L.C. Incident OPBA Representative Grievance First Discussed With Supervisor Meeting Date and time Grievance first discussed with Date and time Article and section number of contract violation Time Place STEP ONE Statement of grievance Grievance (Give timestime, dates, who, what, when, where, why, ): Article and how): Section Numbers Of Contract Violations Remedy requested: Requested Grievant’s signature 's Signature Date and time Received By Date/Time Patrol/Detective Commander STEP ONE Received by Date and time Respondent Name and Title Date of meeting RESPONSE Patrol/Detective Commander’s Signature Date/Time Place Step one response Name and Title Date and Time Received by Grievant Date and Time STEP ONE ANSWER IS: Accepted Rejected Grievant’s Signature Date STEP TWO if applicable Received by By Date/Time Chief of Police Meeting Date and time Respondent Name and Title Date of meeting Time Place Step two response Name and Title STEP TWO RESPONSE Chief of Police’s Signature Date and Time Received by Grievant Date and Time STEP TWO ANSWER IS: Accepted Rejected Grievant’s Signature Date STEP THREE if applicable Received by By Date and time Respondent Name and Title Director of Human Resources Meeting Date of meeting Time Place Step three response Name and Title STEP THREE RESPONSE Director of Human Resource’s Signature Date and Time Received by Grievant Date and Time STEP THREE ANSWER IS: Accepted Rejected Grievant’s Signature Date Referred To OPBA Representative: Yes No Date Referred Approved Disapproved By OPBA Representative (Signature) STEP FOUR if applicable Received by Date and time Respondent - ARBITRATION Notice Served For Arbitration (Name and Title Title) Date of meeting Time Place Step four response Arbitration Notice Received (Name and Title Title) Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected F.O.P./O.L.C. intention to arbitrate (Yes) (No) Signature APPENDIX G PATROL SHIFT BID FORM SHIFT BID PERIODS: On or about January 1st thru April 30th On or about May 1st thru August 31st On or about September 1st thru December 31st YEAR: 2019 2020 2021 EMPLOYEE: On or about January 1st thru April 30th Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about May 1st thru August 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about September 1st thru December 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): Patrol officers will be allowed to bid on a preferred shift assignment each calendar year by seniority. Number the shift bids 1-3 by preference with #1 being the first requested. This form must be submitted by October 1st prior to the year of the bid shifts. Patrol officers not completing this form by the deadline or choosing not to complete the form will be assigned an un-bid shift by the City. Patrol officers will not be allowed to remain on a preferred shift for more than two consecutive cycles regardless of the calendar year (For example, an officer serving on a preferred shift in the second and third cycles may not remain on that shift for the first cycle of the following year). This shift bid system shall be in effect for each year of this agreement. APPENDIX H HURON POLICE DIVISION HOLIDAY COMPENSATION ELECTION FORM Employee Name: Select one of the following designations for the distribution of holiday compensation in accordance with Article 20 of the collective bargaining agreement: Holiday Time Off: Holiday Cash Payment:Supervisor

GRIEVANCE REPORT FORM. PLEASE PRINT OR TYPE A copy of this form must be sent to the O.L.C. Office - IMMEDIATELY Please have your Associate call your Staff Representative when Name of Grievant Badge No. Grievant Xxxxxxxx address Phone No. ( ) Classification Assignment Shift Date of appointment Immediate Supervisor at time of incident O.L.C. Representative Date and time Grievance first discussed with Date and time Article and section number of contract violation Statement of grievance (Give times, dates, who, what, when, where, why, and how): Remedy requested: GrievantXxxxxxxx’s signature Date and time STEP ONE Received by Date and time Respondent Name and Title Date of meeting Time Place Step one response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected STEP TWO if applicable Received by Date and time Respondent Name and Title Date of meeting Time Place Step two response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected STEP THREE if applicable Received by Date and time Respondent Name and Title Date of meeting Time Place Step three response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected STEP FOUR if applicable Received by Date and time Respondent Name and Title Date of meeting Time Place Step four response Name and Title Date and Time Received by Grievant Date and Time ANSWER IS: Accepted Rejected F.O.P./O.L.C. intention to arbitrate (Yes) (No) Signature APPENDIX G PATROL SHIFT BID FORM SHIFT BID PERIODS: On or about January 1st thru April 30th On or about May 1st thru August 31st On or about September 1st thru December 31st YEAR: 2019 2020 2021 EMPLOYEE: On or about January 1st thru April 30th Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about May 1st thru August 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about September 1st thru December 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): Patrol officers will be allowed to bid on a preferred shift assignment each calendar year by seniority. Number the shift bids 1-3 by preference with #1 being the first requested. This form must be submitted by October 1st prior to the year of the bid shifts. Patrol officers not completing this form by the deadline or choosing not to complete the form will be assigned an un-bid shift by the City. Patrol officers will not be allowed to remain on a preferred shift for more than two consecutive cycles regardless of the calendar year (For example, an officer serving on a preferred shift in the second and third cycles may not remain on that shift for the first cycle of the following year). This shift bid system shall be in effect for each year of this agreement. APPENDIX H HURON POLICE DIVISION HOLIDAY COMPENSATION ELECTION FORM Employee Name: Select one of the following designations for the distribution of holiday compensation in accordance with Article 20 of the collective bargaining agreement: Holiday Time Off: Holiday Cash Payment:

GRIEVANCE REPORT FORM. PLEASE PRINT OR TYPE A copy of this form must be sent to the O.L.C. Office - IMMEDIATELY Please have your Associate call your Staff Representative when filing a grievance Name of Grievant Badge No. Grievant address City, State, Zip: Grievant Phone No. ( ) #: Grievant Email: Grievant Cell #: Classification Assignment Shift Date of appointment Immediate Supervisor at time of incident O.L.C. Representative Date and time Grievance first discussed with Date and time Article and section number of contract violation Statement of grievance (Give times, dates, who, what, when, where, why, why and how): Remedy requested: Grievant’s signature Date and time STEP ONE Received by Date and time Respondent Name and Title Date of meeting Time Place Step one response Name and Title Date and Time Received by Grievant Grievant’s Signature Date and Time ANSWER IS: Accepted Rejected STEP TWO if applicable Received by Date and time Respondent Name and Title Date of meeting Meeting Time Place Step two response Name Respondent’s Signature and Title Date and Time Received by Grievant Grievant’s Signature Date and Time ANSWER IS: Accepted Rejected STEP THREE (if applicable applicable) Received by Date and time Respondent Name and Title Date of meeting Meeting Time Place Step three response Name Respondent’s Signature and Title Date and Time Received by Grievant Grievant’s Signature Date and Time ANSWER IS: Accepted Rejected STEP FOUR if applicable Received by Date and time Respondent Name and Title Date of meeting Meeting Time Place Step four response Name Respondent’s Signature and Title Date and Time Received by Grievant Grievant’s Signature Date and Time ANSWER IS: Accepted Rejected F.O.P./O.L.C. intention to arbitrate (Yes) (No) Signature APPENDIX G PATROL SHIFT BID FORM SHIFT BID PERIODS: On or about January 1st thru April 30th On or about May 1st thru August 31st On or about September 1st thru December 31st YEAR: 2019 2020 2021 EMPLOYEE: On or about January 1st thru April 30th Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about May 1st thru August 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): On or about September 1st thru December 31st Day shift (8am to 4pm with Friday/Saturday off): Afternoon shift (4pm to midnight with Friday/Saturday off): Midnight shift (midnight to 8am with Saturday/Sunday off): Patrol officers will be allowed to bid on a preferred shift assignment each calendar year by seniority. Number the shift bids 1-3 by preference with #1 being the first requested. This form must be submitted by October 1st prior to the year of the bid shifts. Patrol officers not completing this form by the deadline or choosing not to complete the form will be assigned an un-bid shift by the City. Patrol officers will not be allowed to remain on a preferred shift for more than two consecutive cycles regardless of the calendar year (For example, an officer serving on a preferred shift in the second and third cycles may not remain on that shift for the first cycle of the following year). This shift bid system shall be in effect for each year of this agreement. APPENDIX H HURON POLICE DIVISION HOLIDAY COMPENSATION ELECTION FORM Employee Name: Select one of the following designations for the distribution of holiday compensation in accordance with Article 20 of the collective bargaining agreement: Holiday Time Off: Holiday Cash Payment:A