File a Grievance – Washington Alliance of Technology Workers

Statement of Occurrence

This is a formal written account detailing the facts and events surrounding a specific incident. We will review the provided information to assess the viability of pursuing a grievance*.
******* Please submit any screenshots and/or pertinent docs to Carissa@washtech.org *******

Full Name

Company Name

Date of Hire / Termination of Employment Date

Work Location/ Department

Manager Name/ Email

Personal Phone Number

Personal Email

Personal Address

Date of Occurrence

Was Disciplinary action taken? .. if so what?

What Article of the Contract, Company Policy, or Law was broken?

Statement of Occurrence (what happened?)

What do you see as a Resolution to this Occurrence?

******* Please submit any screenshots and/or pertinent docs to Carissa@washtech.org *******