Oregon Federation of Nurses and Health Professionals - OFNHP - AFT

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Grievance Form

Local 5017 OFNHP Grievance Form
* Grievance Name:	(Please give your grievance a name)
* Grievant:
* Clinic:
Grievant Address
Address 1:
Address 2:
City:
State:
ZIP Code:
Phone:

Bargaining Group:
Coded Hours:
Step:	1 2 3 4
Date:
Steward:
Steward Address
Address 1:
Address 2:
City:
State:
ZIP Code:
Phone:

Work Site:
Inpatient/Outpatient:	Inpatient 7/70 5/40 Other

* Description:	Give a brief description of the grievance (date, time, shift, who was involved, specific incident, etc
Contract Violations:	Include Article(s) and Section(s)
Remedy:
Signature:
Date Submitted:

Employer Answer:
Signature:
Date Answered:
Send Form to: (optional)
Email 1:
Email 2:
Email 3:
	( Form is also sent to the Internal Organizer at OFNHP )

* Verify:	Enter the letters and numbers from the image above.