Grievance letter

Sample / example grievance letter

From: John Tam

To: Mr/Mrs


Re: grievance letter


I am writing to tell you that I wish to raise a grievance.

This action is being considered with regard to the following circumstances (should describe concisely and clearly with facts and dates, etc.):

1. Describe situations

2. Contents of requirements

I am entitled to a hearing to discuss this matter; also I am entitled, if I wish, to be accompanied by another work colleague or my trade union representative.

Please reply within …….. days of the date of this letter.

Thanks and best regards
Yours sincerely


Sample grievance letter

Step 1 Informal Procedure

Date grievance was informally discussed with 1st level supervisor:_______________________
1st Level Supervisor’s Name:_______________________
Date grievance was informally discussed with 2nd level supervisor:_______________________
2nd Level Supervisor’s Name:_______________________
Note: The employee grievance policy and procedure require you to discuss your issues
with your 1st and 2nd level supervisor prior to filing a formal grievance.

Step 2 Mediation (check one box)

[ ] Yes, I would like to request mediation to help resolve my concerns.
[ ] No, I request to go directly to the grievance hearing committee.
Note: Mediation is a voluntary process that provides individuals in conflict with
opportunity to identify issues, consider options, and arrive at a mutual agreement.
Trained mediators will facilitate open, effective communication to help disputing parties
reach agreement. Essential to the process is the mediator’s ability to maintain neutrality.
Both parties agree in writing to mediate prior to entering the mediation process.
Mediation is considered private and confidential.

Step 3. Formal Hearing

Statement of grievance(s). List the concern(s) you have, the College policies and procedures
believed to have been violated, names, dates, etc., be specific (attach additional pages as
Remedy requested. State what action you believe could be taken, that you feel would resolve
you concern(s).
I affirm that I have read the above and believe the events to be true to the best of my knowledge.
Employee Signature:_________________________
Address:_____________________________ City, State, Zip:_________________________
For Human Resources Use Only
Date grievance was received by the Human Resources Office:__________________________
Mediator Assigned, if selected:_______________________

Related documents

·       Grievance procedure

·       Outcome of grievance meeting letter

·       Invitation letter to grievance meeting

·       Grievance form

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