2018 2021 CBA
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APPENDIX I
GRIEVANCE FORMAT
STEP 1 STEP 2 STEP 3
Grievant’s Name
Campus and Department
Telephone
PSCFA Grievance Committee Representative
Telephone Date of Incident Being Grieved
Section(s) of Collective Bargaining Agreement Related to Grievance:
Specific Description of Violation/Misapplication of Above Section(s) (including resultant harm
to grievant):
Specific Remedy Sought by Grievant:
Step One Response Due Date (14 College business days after receipt of this form)
Step Two Response Due Date (14 College business days after receipt of this form)
Step Three Response Due Date (20 College business days after receipt of this form)
2018 2021 CBA
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Immediate Supervisor Response:
Signature of Grievant Date
Received by (Immediate Supervisor or designee) Date
cc: PSCFA President
Board of Trustees Contract Administrator
*This appendix may be used as a form for submission of a grievance or as a format to
follow when submitting a grievance. Attach additional pages as necessary. Please ensure
that all requested information is included.
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