HTML version of the form: Policy Grievance Presentation (PSLRA s. 220)

Department Use Only

• Reference No.:

Please note: In accordance with PSLRA s. 207, all departments and agencies within the core public administration have an informal conflict management system (ICMS) in place. Its existencedoes not affect the right to file a grievance. However, the employer and bargaining agent representatives are encouraged to use the ICMS when appropriate, at any stage of thegrievance process, in an attempt to informally address workplace differences.

Section 1

This grievance is filed by

• Bargaining agent
• Employer

Section 2 - Bargaining Agent Information

• Bargaining agent:
• Bargaining unit/component:
• Name and title of authorized bargaining agent representative:
• Telephone No.:
• Facsimile No.:
• Address for contact:
• E-mail address:

Section 3 - Employer Information

• Name and title of authorized employer representative:
• Telephone No.:
• Facsimile No.:
• Address for contact:
• E-mail address:

Section 4 - Grievance Details

• Statement of the nature of each act or omission or other matter giving rise to the grievance:
• Date on which each act, omission or other matter giving rise to the grievance occured:
• Department or agency involved (if applicable):
• Collective agreement:
• Expiry date:
• Corrective action requested:

Section 5 - Signatures

• Signature of Bargaining Agent Representative:
• Date:

• Signature of Employer Representative:
• Date:

• Date received:

TBS/SCT 340-53 (2006/02)