FIGHTING MACHINISTS

Grievance Fact Sheet

Date___________________     Grievance Number ________________

Type of Grievance ____________________     I.D. Number___________________________

Grievant________________________________________________________________________

Address________________________________________________________________________

Phone_(_____)__________________    Seniority Date___________________________________

Social Security # _______ / _____ /________

Job Title_________________________________Department_____________________________

Immediate Supervisor_________________________   Superintendent______________________

What happened? (Describe incidents which gave rise to the grievance)______________________
______________________________________________________________________________
______________________________________________________________________________
When did it occur? (Give day, time, date(s)____________________________________________
______________________________________________________________________________
______________________________________________________________________________
Who was involved? (Give names and titles)____________________________________________
______________________________________________________________________________
______________________________________________________________________________
Where did it occur? (Specific locations)_______________________________________________
______________________________________________________________________________
______________________________________________________________________________
Why is this a grievance? (What is management violation? e.g., contract, rules and regulations, unfair

treatment, past practice, local, state, or federal laws, etc.)________________________________

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What adjustment is required? (What must management do to correct the problem)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Additional comments (Include the position of the union)__________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Supervisor’s statement (Include the position of the company)______________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Signature of Steward_________________________________________

Date___________________________________

NOTE: A copy of this form is to be completed by the steward filing the grievance and is to be

placed in the grievance file along with a copy of the grievance and disposition. Additional facts may be

enumerated  on attached sheets.

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