HTML version of the form: Individual Grievance Presentation (PSLRA s. 208)

Protected when completed

Department use only

Please note:
In accordance with PSLRA s. 207, all departments and agencies within the core public administration have an informal conflict management system (ICMS) in place. Its existencedoes 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, atany stage of the grievance process, in an attempt to informally address workplace differences.

Section 1

To be completed by employee



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.


Date on which each act, omission or other matter giving rise to the grievance occurred


Corrective action requested

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

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

Section 4

To be completed by immediate supervisor or local officer in charge

TBS/SCT 340-55 (2006/03)

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