Grievant or Witness Statement form
From: Address: Phone No. Tour/Reporting Time:
GRIEVANT or WITNESS STATEMENT FORM
( ) (
To: American Postal Workers Union, AFL-CIO
)
Local Union:
Email:
(
Re: Regarding an incident/violation that occurred on
)
or about Date:
Facility:
(
)
Issue: _____________________________________
(
1. I
do hereby render this statement on the above issue(s). [State only the Facts ]
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15. What remedy are you seeking?
16.
[ ] Attach addition sheets as needed YOU MUST SIGN THIS FORM Signed:
Date:
APWU REVISED 04/24/2012
American Postal Workers Union, AFL-CIO
Page 2
GRIEVANT/WITNESS S STATEMENT (CONTINUATION)
Local Grievance number: ______________________
bbbb
APWU Revised 04/24/2012
_______________________________________ Signature of Grievant / Witness
................
................
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