Schedule F
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SCHEDULE “F”
GRIEVANCE FORM
TO BE COMPLETED BY GRIEVANT OR HIS/HER REPRESENTATIVE
Name: Title:
Work Location: Supervisor:
State all provisions of Agreement involved:
Article(s): Section(s):
Date of Occurrence:
Statement of Facts (use additional sheets if necessary):
Remedy Sought:
Date Submitted Aggrieved Employee
Date Submitted Program Supervisor
STAGE 1 – DECISION
Date Grievance Received:
Decision (use additional sheets if necessary):
Date Decision Issued Supervisor’s Signature
STAGE 2 – APPEAL
To be submitted to the District Superintendent within ten (10) school days of receipt of Stage 1 – Decision or date Stage 1 – Decision was due, whichever is earlier.
The decision at Stage 1 of the grievance is unsatisfactory.
Short statement of the grievance:
State all provisions of Agreement involved:
Article(s): Section(s):
Remedy Sought:
Date Submitted Aggrieved Employee
STAGE 2 – DECISION
Date Appeal Received:
Decision (use additional sheets if necessary):
Date Decision Issued District Superintendent or Designee
STAGE 3 – APPEAL
To be submitted to the District Superintendent within ten (10) school days of receipt of Stage 2 – Decision or date Stage 2 – Decision was due, whichever is earlier.
The decision at Stage 2 of the grievance is unsatisfactory.
The following issues are unresolved:
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Date Submitted
STAGE 3 – DECISION
Date Appeal Received:
Decision (use additional sheets if necessary):
Date Decision Issued Board of Education
STAGE 4 – APPEAL
To be submitted to the District Superintendent within ten (10) school days of receipt of Stage 3 – Decision or date Stage 3 – Decision was due, whichever is earlier.
The decision at Stage 2 of the grievance is unsatisfactory.
The Ulster BOCES Teachers’ Organization demands arbitration on the following issues:
State all provisions of Agreement involved:
Article(s): Section(s):
Remedy Sought:
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Date Submitted