RESTRICTED – staff (when completed) GRIEVANCE Grievance: Formal Stage Please complete, sign and send direct to your line manager or refer to paragraph 4.11 of the Grievance Resolution Procedure All information relating to Grievances is stored according to the Protective Marking Policy (I13) for ‘RESTRICTED’ documents. Statistical information is provided in quarterly returns to the Home Office and in management reports. Personal information will not be disclosed. For contact your Human Resource Adviser To: ...................................................................................................................… Reference: (name of Line Manager) Grievance Notification to Line Manager This is formal notification of a Grievance. Please endeavour to resolve the issues raised, and give your response to the individual within 10 working days of receipt of this notice. For further advice on the Grievance Procedure please refer to Force Policy, or contact Human Resources at the Business Centre in Kent on 830, or in Essex on 166 166. From: .......................................................................…………………………….. (your name – aggrieved party) Force No. ................................................ Date: ................................................ The information in this section is required for statistics only and should be filled out by the aggrieved individual. Issue(s) being raised: Please tick which box most closely describes the nature of your Grievance: Victimisation Harassment Bullying Disability Discrimination Sex discrimination Selection Terms & Conditions of Employment Racial discrimination Staff Appraisal Other (specify) _______________________________ Is the complaint about an individual? Yes If YES, is that individual Male Police Female Police Staff Specials No Under 25 25 - 40 Over 40 Colleague Supervisor Senior Management Outline the Grievance: Please give the name (if about an individual) of the other party, the nature of your complaint, specific incidents if possible, dates and times when incidents occurred, names of any witnesses to these incidents (please continue on a separate sheet if necessary) Policy No. Form No. 3007 rev Dec 2010 {erev 7/12 ] v4.3 RESTRICTED – staff (when completed) GRIEVANCE RESTRICTED – staff (when completed) GRIEVANCE Describe any action already taken: (informal resolution meeting) Attempts to resolve informally, name of the Supervisor who gave you advice and support (please continue on a separate sheet if necessary). Describe your expectations of the Grievance resolution process: What you expect the outcome to be and any actions you would like to see taken (please continue on a separate sheet if necessary). I declare that the information l have provided on this form is the truth to the best of my knowledge. Signed: ........................................................................................................ Print Name: ....................................................................................... Contact Telephone Number ................................................... NB: This form should now be passed onto your Line Manager Policy No. Form No. 3007 rev Dec 2010 {erev 7/12 ] v4.3 RESTRICTED – staff (when completed) GRIEVANCE