Fillable Printable Employee Grievance Form - Utah
Fillable Printable Employee Grievance Form - Utah
Employee Grievance Form - Utah
EMPLOYEE GRIEVANCE FORM
It is the purpose of the Grievance Procedure to establish a method whereby grievances of
employees will be resolved fairly and effectively. The filing of a grievance will in no way
prejudice the status of the employee. Please see the Policy Manual for a full description of the
procedure (Policy 3-31 and 4-28).
EMPLOYEE: ________________________________ DATE:____________________
DEPARTMENT: _______________________ JOB TITLE: __________________________
STATEMENT OF GRIEVANCE (Background/activity leading to complaint, including dates):
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
REMEDY REQUESTED: _______________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
EMPLOYEE'S SIGNATURE: _______________________ DATE: _______________
Date the Immediate Supervisor was notified: ________________________________
(Please attach response)
Date the Second-Level Supervisor was notified: ______________________________
(Please attach response)
HR-20
