GRIEVANCE FACT SHEET - PPWC Local 1

For Union Use Only
Grievance #*
This should fill in automatically if you clicked the link in the message you received after submitting the original Grievance form. If you don't see a number in this field, put in the number you were instructed to copy from the message after submitting the original Grievance form.
Fact Sheet Submission Date*
MM slash DD slash YYYY
Name*
First Last
Email*
Grievor Info*
Dept Shift Contact Phone
Others Involved

Supervisor and/or Other Management Involved List*

If there are more than one person to list here, click the plus button to add more.

Name	Dept	Job Title

Witnesses or Other Persons Involved List*

If there are more than one person to list here, click the plus button to add more.

Name	Dept	Job Title

Shop Steward Assisting*
Name Dept Job Title
Greivance Information
What happened? What is the grievance about?*
When did the grievance occur?*
Where did the grievance occur?*
Why is this a grievance?*
Want? (what type of redress? Adjustments necessary to completely correct situation.)*
Additional comments or witness statements.*
Comments
This field is for validation purposes and should be left unchanged.

For Union Use Only