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):

Date the Second-Level Supervisor was notified: ______________________________