Grievance Forms

 

 

 

GRIEVANCE REPORT – FORM A

STEP #1

 

FROM:

,

Grievant

 

TO:

Barbara Dalrymple,

Grievance Officer

 

DATE:

 

 

 

DESCRIPTION OF HAPPENING:

 

 

 

 

 

 

 

 

 

 

 

 

(Signature)

 

 

(This Portion To Be Used By Grievance Officer ONLY)

STEP #2

Grievance Number

 

 

TO:

,

Grievant

 

FROM:

Barbara Dalrymple,

Grievance Officer

 

DATE:

 

 

RESPONSE TO GRIEVANCE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Date Grievance Received)

 

(Grievance Officer)

 
                             

 

NOTE:     Submit Grievance Report In Triplicate


 

 

 

 

 

 

 

 

 

 

 

APPEAL – FORM B

STEP #3

Grievance Number

 

 

FROM:

,

Grievant

 

TO:

,

Superintendent

 

DATE:

 

 

 

“Grievance Report Form A is hereby attached for APPEAL to the Superintendent.”

 

 

 

 

 

 

 

 

 

 

 

 

(Signature)

 

 

(This Portion To Be Used By Superintendent ONLY)

STEP #4

 

 

 

TO:

,

Grievant

 

FROM:

,

Superintendent

 

DATE:

 

 

RESPONSE TO GRIEVANT’S APPEAL:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Date Grievance Received)

 

(Grievance Officer)

 
                               

 

NOTE:     Submit APPEAL Form B In Triplicate


 

 

 

 

 

 

 

 

 

 

 

SECOND APPEAL – FORM C

STEP #5

Grievance Number

 

 

FROM:

,

Grievant

 

TO:

 

 

 

DATE:

 

 

 

“The attached Grievance Forms A and B, are hereby submitted for your information,

pertaining to my complaint.”

 

 

 

 

 

 

 

 

 

 

 

 

(Signature)

 

 

 

STEP #6

 

 

 

TO:

,

Grievant

 

FROM:

 

 

 

DATE:

 

 

RESPONSE TO SECOND APPEAL:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Date Grievance Received)

 

(Grievance Officer)

 
                               

 

NOTE:     Submit Second APPEAL Form C In Triplicate