Grievance Form

Initiating Action
You and your job
Your Full Name       Department      
Job Title       Section      
Phone Number       Work Address      

Your representative (if you have one)

Full Name       Union/Organisat      
ion
Phone Number       Address      

Remedy sought
Briefly describe what you want to happen. How can matters be put right? What will resolve your
grievance?
     

Issues and people involved

1I feel I have been treated unfairly or wrongly as a result of:-

(Please tick any appropriate box)
the conduct of one or more people;
a management decision which is wrong or unfair;
the operation of a College procedure or practice which is unfair;
some other substantial reason.
Please give the following information (if you have it) about any people directly involved:-
Full Name Job Title Department
                 
                 
                 
                 
                 
                 

HR14 1 Version 1: May 2008

Grievance Form
Initiating Action

Describe any incidents

Date of incident      
Description
     
Date of incident      
Description
     
Date of incident0      
Description

Date of incident      

Description
     

Please summarise your complaint

What is it about these incidents that you are complaining about?
     

HR14 2 Version 1: May 2018

Grievance Form
Initiating Action
Action already taken
Briefly describe what you have already done to raise and resolve the issue:
     

Preferred approach to resolving the issue

No blame approach
Sometimes, an employee may simply want the treatment of which they are complaining to stop.
Sometimes, seeking to apportion blame may raise the stakes and thus get in the way of finding
a practical and effective remedy to a grievance. However, in some cases, the College may have
an over-riding duty to take action under the disciplinary procedure or to involve audit, or other
external agencies such as the police. Such cases are not appropriate for a “no blame” approach.
2Please indicate your preference:
Yes, I want the grievance to be handled using a no-blame approach
No, I do not want the grievance to be handled using a no-blame approach
Other options for resolving the grievance
How do you think the remedy you have outlined above can be achieved?
Arbitration
Mediation
Counselling for some or all of the staff involved
(More information about the processes above is set out in the document Key Concepts:
Grievance, available on the HR web-site or from the HR Department.)
Some other plan of action (please say what below)
     

Signature and Declaration

1 I declare that I am raising this matter in good faith and that the details I have given are
accurate to the best of my knowledge.
2 The matter can be properly dealt with under the Grievance procedure and is not about:
–a a decision taken under a procedure which offers a right of appeal
–b a decision to apply an HR Code of Practice
–c work issues over which the College has no discretion or authority.
Signature Date
     

HR14 3 Version 1: May 2008