OFFICIALUNION GRIEVANCE
FORMName of Employer___ _ _ _ Phone (),_ ___ _Include Area Code)Name of Local Union _ Phone ( Statement of Grievance: List what happened, where, when , why. Also, any contract violation.Adjustment or Settlement Requested: (To be completed by Union)I authorize the Union to act for me in the disposition of this grievance and authorize the employer to release any information requested by the Union regarding this grievance.x _ _
x_ _ Signature of Gr evant Signature of Local Union Representative DateName of Employer Representative who handled the grievance at the following steps:Verbal Step_ _ 1st Written Step 2nd Written Step __ _ Employer’s Answer to 1st Written Step: if grievance is denied, give reasons and proofs.Employer’s Answer to 2nd Written Step:{j)(!)n3:l 0 (I)zc3cr(…I.)..X—–s=;gnature o..t,..E..m,,-p.,.oyer -R=e-presentat:ive——NOTICE TO LOCAL UNION – Make 3 Copies: (1) Employer, (2) Union, (3) Local Union. Be sure to send all proofs and evidence to the Union office along with Grievance.1