Source: XpertHR P&D Date: 12/10/2007 Publisher: XpertHR

Grievance procedures: Grievance record form (form)

TOPICS:
terms, conditions and employee rights policies and procedures

AUTHOR: Lynda Macdonald


Form wording:

Name of employee who raised the grievance:  
Employee's job title:  
Employee's department:  
Date grievance raised:  
Date of grievance hearing:  
Name of manager conducting grievance hearing:  
Employee accompanied by:  
Summary of employee's grievance:

 

 

 

Conclusions reached/decisions made/actions agreed following grievance hearing:

 

 

 

Date employee notified of outcome:  
Employee appealed the decision/did not appeal the decision (delete as appropriate)
Date of employee's appeal:  
Date of appeal hearing:  
Name of manager conducting appeal hearing:  
Employee accompanied by:  
Date form submitted:  
Summary of basis for employee's appeal:

 

 

 

Appeal upheld/rejected (delete as appropriate)
Rationale for upholding/rejecting appeal:

 

 

 

Date employee notified of outcome of appeal:  
Any further comments:

 

 

 

Form completed by:  
Signature:  

When to use this document

Use this document to maintain clear, complete and consistent records of grievances raised by employees and the steps taken to deal with them.

Law relating to this document

Leading statutory authority

Employment Rights Act 1996
Employment Relations Act 1999
Employment Act 2002
Employment Act 2002 (Dispute Resolution) Regulations 2004 SI 2004/752
ACAS Code of Practice on Disciplinary and Grievance Procedures (PDF format, 327K) (on ACAS website)

The Employment Act 2002 (Dispute Resolution) Regulations 2004, in force from 1 October 2004, provide that all employers (including small employers) must operate minimum dispute resolution procedures for all employees.

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