HTML version of the form: Grievance Transmittal Form
Grievance Transmittal Form
(PDF, 28 KB)
Protected when completed
Department use only
Reference No.:
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
- Level 2
- Level 3
- Level 4
- NJC level 2
- NJC final level
Section 2
To be completed by employee (not applicable for group grievances)
- Surname
- Given names
- Telephone No.
- Department or agency
- Branch/division/section
- Work location
- Employee signature
- Date
Section 3
To be completed by 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 4
To be completed by immediate supervisor or local officer in charge
- Name and title of management representative
- Date transmittal received
- Signature
TBS/SCT 340-54 (2006/02)