Grievance Form

Grievance Template 

Protected B (when completed)

Memo

5080 -1 [Member’s Service Number]

Date [DD/MM/YR]

Commanding Officer

REQUEST FOR REDRESS OF GRIEVANCE –

[SN], [RANK], [INITIALS], [SURNAME]

 

Refs: A. NDA Section 29

B. QR&O Chapter 7

C. Additional refs as they pertain to the grievance (For example, for a PER grievance CFPAS, a compensation issue would be CBI and the relevant number) 

  1. I, rank, initials, surname submit this memorandum as a request for redress of grievance.
  2. [Issue: Particulars of the decision, act or omission being grieved and the date that this decision, act or omission occurred and/or became known to. An explanation as to how it affects/impacts you.]
  3. [Supporting Information: Supporting evidence, policies, documents and witness statements (if applicable)]
  4. [Remedy) I will consider this request for redress to be satisfied when (state what events/actions must occur for the grievance to be satisfied.]

    [ENTER GRIEVANCE SUBMISSION CONTENT HERE] 

[Signature of Member]

[Initials] [Surname] [Rank] [Position]

Enclosure(s): If applicable

 

IMPORTANT POINTS

  1. A grievance must be signed by the member. (QR&O Art 7.04 (1))
  2. A grievance can be one issue or multiple issues. Each issue must be identified separately with in the grievance and supported.
  3. A grievance may be typed or hand written, keep in mind that hand writing must be legible.
  4. A grievance submitted beyond the three month time limit MUST also contain an explanation for the delay.

 

Protected B (when completed)