Intake Form

Use this form to file a grievance.

Leader's name

First Name

Last Name

Leader's phone

(###)

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Best time to call leader (First choice)

Best time to call leader (Second choice)

Leader's email

Place of work

Individual or group grievance?

Name of person or description of group with the issue

Phone number of individual

Leave blank if this is a group grievance

(###)

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Type of Issue

Brief description of issue

Is this a termination, suspension, or final warning?

Date of incident

If applicable

YYYY

Date of discipline

If applicable

YYYY