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LRFOA - GRIEVANCE CASE FORM
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* Indicates required question
Email
*
Your email
Date:
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MM
/
DD
/
YYYY
Grievance Presented By:
*
Your answer
Date of Grievance Occurrence:
*
MM
/
DD
/
YYYY
Time of Grievance Occurrence:
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Time
:
AM
PM
Place of Grievance Occurrence:
*
Your answer
Grievance Statement by Aggrieved Member:
*
Your answer
Date Grievance Sent to Grievance Committee Chair:
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MM
/
DD
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YYYY
Date Grievance sent to LRFOA President:
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MM
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DD
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YYYY
Date, you, as the Aggrieved Member sent your response to LRFOA Board:
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MM
/
DD
/
YYYY
Aggrieved Member’s Signature:
*
Your answer
Date Signed:
*
MM
/
DD
/
YYYY
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