Grievance Consent Form

PROTECTED A (when completed)



To: Canadian Armed Forces

Grievor’s name:[Rank] [Name]

Grievance Number: 5080-1-______________


I consent to the release to the various organizations involved in the Canadian Armed Forces Grievance System, Including the Canadian Armed Forces Grievance Authority and the Military Grievances External Review Committee, of all personal information that may be relevant to the resolution of my grievance, such as personnel records, reports, documents or data, medical or hospital notes or notes connected with any medical treatment or counselling provided to me. I expressly authorize the examination of such information by any person retained to review my grievance.The Canadian Armed Forces and the Military Grievances External Review Committee are committed to respecting the privacy of individuals whose grievances are being considered. All personal information will be handled in accordance with the provisions of the Privacy Act and Canadian Armed Forces Regulations.

Dated this __________________ day of _______________________________at _________________________ in the Province of ________________________


Grievor’s Signature


PROTECTED A (when completed)

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