CANADIAN UNION OF POSTAL WORKERS

 GRIEVANCE INVESTIGATION FORM

-CONFIDENTIAL-

Part "A"

(To be completed by the grievor with help from the Shop Steward.)

Last Name:

Given Name:

Address:

City:

Province:

Postal Code:

Telephone Number: -

Employee Number:

First Date of Service: ,

Name of Company:

Classification: Shift:

Section:

Work Location:

Telephone Number: -

Time of Shift: From: To:

Local:

Employee: Full Time Part Time

Temporary Probation

Name of Shop Steward:

Date of Investigation:

Part "B" (To be completed by the grievor or the witness(es) with the help of the Shop Steward).

Grievor:

The incident given rise to the grievance occurred on:

Date: , Time: Location:

Persons involved: Supervisor: Witness:

Supervisor: Witness:

In your own words, state all the facts.

 

On what date did you become aware, for the first time, you had a grievance? ,

I hereby authorize the representative(s) of the C.U.P.W. to examine my personal file.

 

(Signature) _________________________________

Part "C" - To be completed by the Shop Steward

Verification: Date and time of incident

(Check) Written statement of witnesses

Supporting documentation for the grievance

(i.e. letter, opportunity list, etc.)

Specific cases where documentation is required for grievance representation:

Overtime * Copy of equal opportunity for overtime list

Leave * Copy of notice of leave without pay; copy of request for leave form;

* Copy of medical certificate; copy of Summons from Court

Salary, premiums,

Allowances * Copy of letter from employer; cheque stub; memo; etc.

Discipline * Copy of notice of interview; copy of letter from employer;

signature and written statement of witnesses.

Additional information from the Shop Steward:

(Employer’s comments, if applicable.)

Corrective action requested:

This form is the exclusive property of the Canadian Union of Postal Workers and must be sent to the grievance officer as soon as it is completed. Any unjustified delay could breach the validity of the grievance.
FOR USE BY THE LOCAL

1.) Name of the officer responsible: ___________________________________________________________________

2.) For any disciplinary measure (including absenteeism), please attach to this form a summary of the grievor’s personal file.

Signature: _________________________________________________ Date: _________________________