HTML version of the form: Individual Grievance Presentation (FPSLRA s. 208 or s. 238.24)
Protected when completed
Department use only
- Reference No.
Please note:
In accordance with FPSLRA s. 207, all departments and agencies within the core public administration have an informal conflict management system (ICMS) in place. Its existence does not affect an employee’s right to file a grievance. However, managers, employees and bargaining agent representatives are encouraged to use the ICMS when appropriate, at any stage of the grievance process, in an attempt to informally address workplace differences.
Section 1
To be completed by employee
A
- Surname
- Given names
- Home and work telephone No.
- Home address
- Job classification
- Department or agency
- Branch/division/section
- Position title (and number)
- Work location
- Shift
- E-mail address
- Collective agreement (if applicable)
- Expiry date
B
Grievance details: statement of the nature of each act or omission or other matter giving rise to the grievance that establishes the alleged violation or misinterpretation,including a reference to, as the case may be, (i) any provision of a statute or a regulation, or of a direction or other instrument made or issued by the employer, that deals with the terms and conditions of employment and that is relevant, or (ii) any provision of a collective agreement or an arbitral award that is relevant.
C
Date on which each act, omission or other matter giving rise to the grievance occurred
D
Corrective action requested
- Signature of employee
- Date
Section 2
To be completed by the bargaining agent representative where applicable
Approval for presentation of grievance relating to a collective agreement or an arbitral award, and agreement to represent employee are hereby given
- Signature of Bargaining Agent Representative
- Date
- Bargaining agent
- Bargaining unit/component
- Name of local bargaining agent representative
- Telephone No.
- Facsimile No.
- Address for contact
- E-mail address
Section 3
To be completed by employee where representative is not a representative of a bargaining agent
I agree to act on behalf of the employee
- Signature of representative
- Date
- Name of representative
- Telephone No
- Facsimile No.
- Address for contact
- E-mail address
Section 4
To be completed by immediate supervisor or local officer in charge
- Name and title of management representative
- Date received
- Signature
TBS/SCT 340-55 (2006/03)